The diagnosis, localization, and treatment of pancreatic islet cell tumors, specifically insulinomas, remain a challenging area of general surgery. Once identified, location of these tumors may prohibit a less morbid enucleation leaving large resection as the only alternative. This video describes a laparoscopic technique of transecting the duodenum to gain access to the uncinate process and allow enucleation of an insulinoma preventing a large abdominal incision and a more extensive pancreatic resection. A 42 year old man presents with a six month history of 30 pound weight gain and symptoms of dizziness and lightheadedness relieved with consumption of fruit juices and food. Clinical evaluation showed a ratio of glucose to insulin greater than 0.5 and an elevated C-peptide level. Radiologic studies including an abdominal CT, an abdominal MRI, endoscopic ultrasound, and an octreatide scan shoed a mass in the uncinate process. The patient underwent a laparoscopic exploration. Location of the insulinoma deep within the uncinate process near the superior mesenteric vessels limited access from the ventral and dorsal pancreatic surfaces. Transection of the duodenum created a window to the uncinate process and allowed simple enucleation of the insulinoma. Intestinal continuity was re-established with a duodenoduodenostomy. The patient's hospital stay was five days. He had a low output pancreatic fistula treated successfully with medical management. He has experienced no further episodes of dizziness and has lost twenty pounds since surgery.