Minimally invasive pancreaticoduodenectomy (PD) is an increasingly utilized surgical approach for pancreatic cancer. Despite its benefits, PD presents significant challenges, particularly during the reconstruction phase, which requires three anastomoses: pancreatic, biliary, and gastric. Among these, pancreatic anastomosis is the most complex and critical, as it is closely associated with the risk of postoperative pancreatic fistula. Factors such as soft pancreatic parenchyma and a small, posteriorly located duct elevate this risk. Various PA techniques have been developed, including pancreaticojejunostomy and pancreaticogastrostomy, but no single technique has proven superior to the others. Techniques such as Blumgart anastomosis and double purse-string pancreaticogastrostomy are tailored to specific pancreatic duct characteristics and parenchymal conditions. Advancements in minimally invasive surgery, especially robotic-assisted approaches, have improved precision and ergonomics, mitigating technical difficulties during reconstruction. Standardized techniques, high-volume surgical centers, and the use of tools like the Fistula Risk Score are crucial for optimizing outcomes. For biliary and gastric anastomoses, meticulous technique and strategic adjustments, such as antecolic positioning and the use of stents, aim to minimize complications. This chapter provides a comprehensive overview of minimally invasive PD, detailing technical strategies, indications, and management of complications, emphasizing the importance of expertise in reducing morbidity and mortality.