We present a 77 year old male with carcinoma in-situ of the Ampulla of vata given his advanced age, co-morbidities, and an intraoperative frozen section revealing no invasive cancer, a local ampullary resection was performed. The procedure demonstrated is open laparotomy with exploration for metastasis, Kocher maneuver, duodenotomy, local papillary resection with frozen section, and reimplantation of the ampulla, with discussion of recent data regarding local excision for ampullary tumors.