Laparoscopic resection of the uncinate process of the pancreas: the inframesocolic approach and hanging maneuver of the mesenteric root



Laparoscopic pancreatic procedures have increased in recent years. However, only a single case of laparoscopic uncinatectomy has been reported to date, performed through an anterior approach. This video presents a hitherto undescribed laparoscopic inframesocolic approach and also an undescribed maneuver to expose the uncinate process.


A 39-year-old women had a 16-mm insulinoma in the uncinate pancreas. The patient was placed in the supine position with legs apart. A 30º, 5-mm optic was used, and only a 12-mm trocar was needed. The first maneuver moved the major omentum and transverse colon upward to expose the mesenteric root. The duodenum was identified through the peritoneal sheath and mobilized. The superior mesenteric vein was identified and carefully exposed in the vicinity of the uncinate pancreas. To improve the exposure for the uncinatectomy, a hanging maneuver of the mesenteric root was performed with cotton tape. Intraoperative ultrasound identified the tumor and defined the limits of the resection. An inferior pancreaticoduodenal vein was sectioned between clips, and the uncinate process was dissected from the retropancreatic fascia. The transection was performed with a reinforced endostapler. The specimen was dragged into a bag and removed through the 12-mm orifice, which did not have to be enlarged. No drain was left.


The patient was discharged on postoperative day 3. No early or late surgical complications were observed. At this writing 1 year after the procedure, the patient has lost 35 kg and shows a normal body mass index. She remains asymptomatic with normal blood sugar levels.


Laparoscopic resection of the uncinate process of the pancreas is feasible and safe. The inframesocolic approach is easy to perform and achieves an optimal exposure that is improved with a hanging maneuver of the mesenteric root.

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  1. 1.

    Sperti C, Beltrame V, Milanetto AC, Moro M, Pedrazzoli S (2010) Parenchyma-sparing pancreatectomies for benign or borderline tumors of the pancreas. World J Gastrointest Oncol 2:272–281

  2. 2.

    Takada T, Amano H, Ammori BJ (2000) A novel technique for multiple pancreatectomies: removal of unicinate process of the pancreas combined with medial pancreatectomy. J Hepatobiliary Pancreat Surg 7:49–52

  3. 3.

    Sharma MS, Brams DM, Birkett DH, Munson JL (2006) Uncinatectomy: a novel surgical option for the management of intraductal papillary mucinous tumors of the pancreas. Dig Surg 23:121–124

  4. 4.

    Poves I, Burdio F, Iglesias M, Martinez-Serrano Mde L, Aguilar G, Grande L (2009) Resection of the uncinate process of the pancreas due to a ganglioneuroma. World J Gastroenterol 15:4334–4338

  5. 5.

    Busquets J, Fabregat J, Borobia FG, Jorba R, Valls C, Serrano T, Ramos E, Pelaez N, Rafecas A (2010) Organ-preserving surgery for benign lesions and low-grade malignancies of the pancreatic head: a matched case-control study. Surg Today 40:125–131

  6. 6.

    Nakagohri T, Kinoshita T, Konishi M, Takahashi S, Gotohda N, Kobayashi S, Kojima M, Miyauchi H, Asano T (2010) Inferior head resection of the pancreas for intraductal papillary mucinous neoplasms. J Hepatobiliary Pancreat Sci 17:798–802

  7. 7.

    Fernández-Cruz L, Blanco L, Cosa R, Rendón H (2008) Is laparoscopic resection adequate in patients with neuroendocrine pancreatic tumors? World J Surg 32:904–917

  8. 8.

    Machado MA, Makdissi FF, Surjan RC, Machado MC (2009) Laparoscopic resection of uncinate process of the pancreas. Surg Endosc 23:1391–1392

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Fernando Rotellar, Fernando Pardo, Alberto Benito, Pablo Martí-Cruchaga, Gabriel Zozaya, and Javier A. Cienfuegos have no conflicts of interest or financial ties to disclose.

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Correspondence to Fernando Rotellar.

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Rotellar, F., Pardo, F., Benito, A. et al. Laparoscopic resection of the uncinate process of the pancreas: the inframesocolic approach and hanging maneuver of the mesenteric root. Surg Endosc 25, 3426 (2011) doi:10.1007/s00464-011-1740-z

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  • Insulinoma
  • Laparoscopy
  • Limited pancreatic resection
  • Pancreas
  • Uncinate process
  • Uncinatectomy