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Purpose: Pancreatoduodenectomy has been developed over more than 100 years, with contributions being made by many countries to the various aspects of the technique. Methods: This review outlines the contributions of America toward the technical conduct of the procedure. Results: There have been seven phases of the development and refinement of pancreatoduodenectomy from 1935 until now: Phase 1, development and feasibility (1935-1950); Phase 2, radicality of the procedure (1960-1975); Phase 3, total pancreatectomy (1960-1975); Phase 4, pylorus preservation (1975-1985); Phase 5, surgical experience trials (1980-2000); Phase 6, adjuvant treatments (1990 to now); and Phase 7, minimally invasive techniques (1995 to now). Conclusions: In conjunction with Japan, Germany, Italy, France, and many other countries, North America has contributed substantially to the development of the current, state-of-the-art performance of pancreatoduodenectomy and its evaluation. [ABSTRACT FROM AUTHOR]