Self-traction Method for Uncinate Process Dissection During Laparoscopic Pancreaticoduodenectomy

Background Dissection of the uncinate process is one of the most challenging procedures in laparoscopic pancreaticoduodenectomy and is also oncologically important to secure the retroperitoneal resection margin. In this study, we introduced a traction method that could provide stable lateral traction of the uncinate process to elevate it to allow better visualization of the retroperitoneal resection margin between the uncinate process and the superior mesenteric artery. Methods The pancreatic head and duodenal unit were encircled using a 25-cm-long nylon tape and an elastic rubber band was used to tract it. The elastic power of the rubber band induces gradual automatic self-traction that allows the surgeon to proceed with the dissection without any other manipulation. With the help of this traction method, both of the operator's hands were free from the traction. Results This video demonstrated the setting for the application of our self-traction method and how it can be used to achieve a proper operative field during uncinate process dissection. Conclusion This simple traction method could allow better exposure of the operative field and provide a stable operative environment.