Minimizing intraoperative bleeding represents a surgical quality index and an important prognostic factor for postoperative outcomes. High blood loss could contribute to the onset of pancreatic fistula and postoperative complications by triggering mechanisms that interfere with the anastomosis healing process. The best way to treat a complication is to prevent it, so preoperative study is crucial in the prevention of intraoperative hemorrhage. In minimally invasive pancreatoduodenectomy (PD), the two most important variables to evaluate before surgery are the presence of anatomical variants and the neoplastic involvement of vessels. The most accurate imaging technique for vascular anatomy is the 3-phase computed tomographic angiography (CTA). New technologies allow surgeons to simulate the planned surgical intervention improving their procedural choices. The artery-first represents the preferred approach for oncological reasons and for the safety it guarantees on bleeding control. Indeed, it allows an easier identification and ligation of the inferior pancreaticoduodenal arteries before the afferent veins and it enables simpler recognition and preservation of aberrant right hepatic artery (RHA) or common hepatic artery (CHA) originating from super mesenteric artery (SMA). Surgeon experience contributes to reducing bleeding and improving outcomes in minimally invasive PD.