Open distal pancreatectomy with or without splenectomy has been commonly employed for the treatment of a variety of pancreatic diseases. Although many general surgical procedures have been increasingly performed laparoscopically or with laparoscopic assistance, until the current decade, laparoscopic pancreatic surgery had not been performed. Surgeons at Indiana University Hospital have safely applied laparoscopic surgery to very select patients with pancreatic disease since 2003. Recently, the outcomes of laparoscopic distal pancreatectomy at Indiana University in combination with multiple other institutions were reviewed and presented at the American Surgical Association Meeting 2008. These data suggest that laparoscopic when compared with open distal pancreatectomy may be associated with lower blood loss (357 vs. 588 cc, p<0.01), fewer complications (40 vs. 57%, p<0.01), and shorter hospital stays (5.9 vs. 9.0 days, p<0.01). Furthermore, the laparoscopic approach was an independent predictor of shorter hospital stays. The main criticism of this retrospective study and similarly designed studies is that there is likely to be a selection bias in patients who undergo laparoscopic distal pancreatectomy which may account for the apparent positive results in favor of laparoscopic distal pancreatectomy. In other words, patient factors, not the operative approach may be more predictive of the outcome.