In recent years, minimally invasive pancreaticoduodenectomy (MIPD) has gained attention, though it remains technically demanding due to its steep learning curve and the need to replicate oncological principles of the open approach. A critical technique for achieving negative margins and safer mesopancreatic dissection is the superior mesenteric artery (SMA) first approach, which has garnered interest among pancreatic surgeons. This chapter provides a comprehensive step-by-step guide to five different SMA-first approaches for MIPD, presented by expert surgeons from international institutions. By detailing these techniques, this chapter aims to assist surgeons in selecting the appropriate approach based on tumour location, type of minimally invasive method, and surgeon experience. The guidance and insights offered are intended to improve familiarity and safety with this complex procedure, enhancing its application in pancreatic surgery.