Abstract:Objective: To investigate the anatomical characteristics of the superiormesenteric vessels, so as to provide anatomical landmarks for reference during the performance of laparoscopic pancreaticoduodenectomy (PD) with uncinate process approach. Methods: Anatomical dissection in 4 adult human cadaveric specimens was performed, and the image data of computed tomography angiography (CTA) for upper abdomen using CT from 96 cases and video data of laparoscopic PD with uncinate process approach of 13 patients were analyzed. Results: Portal–superior mesenteric veins could be described as three portions that comprised the superior pancreatic portion, where the gastric coronary vein drained into its right side in some cases (22.1%), the pancreatic portion, presenting as a confluence of several vein tributaries such as gastrocolic trunk, posterior inferior pancreaticoduodenal vein and posterior pancreaticoduodenal vein, and the inferior mesenteric vein was also seen draining into its left side (7.5%), and the horizontal duodenal portion, where no vein branch was observed and the superior mesenteric artery was closely adjoined to the left side. The superior mesenteric artery was seen running alongside the superior mesenteric vein within the region of the head of the pancreas and the duodenum, with the inferior pancreaticoduodenal artery as its main branch, which was also found forming a common trunk with the first jejunal artery (33.0%). Replaced right hepatic artery arising from the superior mesenteric artery was found in two cases (1.8%). Conclusion: Adequate knowledge of the distribution and flowing courses of the superior mesenteric vessels and their associated vessels is of great clinical importance in laparoscopic PD, and the duodenal portion of superior mesenteric vein can be used as a main anatomical landmark for the uncinate process approach.