Segmental duodenectomy provides a surgical option for certain lesions of the duodenum. This precludes the need for procedures associated with higher morbidity secondary to pancreatic resection or pancreatobiliary anastomoses. Depending on the location of the lesion, either a proximal segmental duodenectomy (PSD) or a distal segmental duodenectomy (DSD) can be performed. Both segmental resections require adequate preoperative planning and are contingent on careful dissection along anatomic planes. This chapter provides a technical overview of different surgical options for segmental resection of the duodenum with pancreas preservation.