Background and Aims Laparoscopic pancreaticoduodenectomy (LPD) is one of the most technically demanding procedures in general surgery. Its development remains controversial, particularly regarding adherence to oncological principles. In situ LPD, based on the "no-touch" principle, offers a treatment option for pancreatic tumors. However, ensuring surgical safety remains a key challenge due to its technical complexity. This study explored the surgical techniques of in situ LPD performed via the left-sided combined middle approach and evaluated its safety and efficacy.Methods A retrospective analysis was conducted on the clinical data of four patients who underwent in situ LPD using the left-sided combined middle approach between July 2023 and November 2023 at the Department of Pancreatic Surgery of Fudan University Shanghai Cancer Center and the Department of Hepatobiliary Surgery of Yijishan Hospital, Wannan Medical College.Results All 4 patients were female, with an average age of 58 and a mean BMI of 22.1 kg/m². Among them, two had pancreatic head cancer, one had ampullary carcinoma, and one had distal common bile duct carcinoma. Preoperative laboratory indicators, including white blood cell count, platelet count, prothrombin time, alanine aminotransferase, aspartate aminotransferase, albumin, total bilirubin, and direct bilirubin, were all within normal ranges. All patients successfully underwent in situ LPD via the left-sided combined middle approach. The mean operative time was 385 min, with an average intraoperative blood loss of 87.5 mL. After operation, the average drainage tube removal time was 10.3 d, and the mean hospital stay was 10.8 d. One patient developed biochemical leakage, and another experienced abdominal effusion, while no cases of biliary stricture, diarrhea, or chylous leakage were observed.Conclusion In situ LPD via the left-sided combined middle approach allows for thorough lymph node dissection and radical tumor resection while adhering to the "no-touch" principle. This approach is simple to perform and master and does not lead to significant postoperative complications. It is a safe and feasible technique with promise for broader clinical application. Future research should focus on multicenter studies with larger sample sizes to validate its safety and efficacy.