Left-side approach to the uncinate process during laparoscopic pancreaticoduodenectomy

The mobilization of the uncinate process is considered a difficult step during laparoscopic pancreaticoduodenectomy. The standard approach from the right side of the superior mesenteric artery requires to apply a major tension on the mesenteric vessels to dissect the uncinate process, such tension may increase the risk of injury and massive bleeding from pancreaticoduodenal vessels. We report an original technique for the mobilization of the uncinate process from the left side of the superior mesenteric artery which combine the advantages of the laparoscopic view from the left side to a reduced tension on the mesenteric vessel for the exposure of the operating field. The left side approach allows a safe and bloodless mobilization of the uncinate process in lean patients with small uncinate process as well as in obese patients with large uncinate process.