title: Uncinate process first--a novel approach for pancreatic head resection.
abstract: OBJECTIVE
  Partial pancreatico-duodenectomy is the standard treatment for malignancies of the pancreatic head. We describe a technical modification with a retrograde dissection of the pancreatic head as a novel surgical approach.
  
  
  METHODS
  Retrograde resection of the pancreatic head is performed starting with the uncinate process after division of the first jejunal loop and transection of the pancreas as the last operative step of the resection. Technical aspects and possible advantages for this procedure are discussed.
  
  
  RESULTS
  The retrograde resection can be safely performed and offers a comfortable and innovative approach for pancreatico-duodenectomy.
  
  
  CONCLUSIONS
  The "uncinate process first" approach can serve as an additional approach in modern pancreatic surgery. Further studies are required to evaluate this procedure regarding operative parameters and postoperative outcome compared to the standard resection.
authors.affiliation: Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Thilo
authors.initials: T
authors.lastname: Hackert
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
authors.forename: Jan
authors.initials: J
authors.lastname: Schmidt
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D004210:Dissection / Q000379:methods; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008197:Lymph Node Excision / Q000379:methods; D010179:Pancreas / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D017792:Surgical Stapling