Background: The role of diagnostic laparoscopy is well accepted in the staging of pancreatic body and tail lesions. Similarly, the feasibility of laparoscopic distal pancreatectomy (LDP) has been demonstrated. To evaluate the indications, safety, and efficacy of LDP we retrospectively review our initial experience with this procedure. Patients and Methods: This study reports a single institution experience with 13 consecutive patients (6 F, 7 M, average age 51±16), from 2002 to 2005 whose planned operation was a LDP. Charts were retrospectively reviewed for procedure indication, complications and post-operative outcome. Data are expressed as median value (range 5th-95th percentile). Results: 8 (62%) pancreatic lesions were incidentally found on CT scan. Indication for surgery in asymptomatic patients was the need for diagnosis and a concern for neoplasm. Average lesion size was 2.9 x 2.6 cm. Pathology showed 4 endocrine tumor (3 islet cell and 1 VIPoma), 2 mucinous cystadenoma, 1 adenocarcinoma, 1 plasmacytoma and 5 benign lesions (3 serous cystadenoma, 1 accessory spleen, 1 dermoid cyst). Only 1 procedure was converted to open secondary to high suspicion for malignancy. 11 patients (85%) had a distal pancreatectomy and splenectomy, while 2 (15%) had a splenic preservation. Median operative time was 4.5 hours (range 3-6), median intraoperative blood loss was 75 cc (28-670). There were no deaths. Complications included 1 pneumothorax, 2 self-limited pancreatic leaks, 1 symptomatic pseudocyst presenting two months post operatively and requiring surgical treatment. The median length of hospital stay was 6 days (range 4-10), median diet resumption was 3 days (1-8) and patient controlled anesthesia was discontinued after a median of 3 days (range 0-9). All patients with benign disease had an excellent outcome at a median of 7 months follow up (range 2-24). A single patient who was converted for malignant disease survived for 30 months. Conclusions: Laparoscopic surgery for resection of pancreatic lesions remains a technically challenging operation. At centers where expertise exists in both laparoscopic and pancreatic surgery, the technique is being increasingly used and offers a valuable tool for the diagnosis and treatment of incidentally discovered pancreatic lesions. This retrospective audit establishes the safety and confirms the effectiveness of LDP even early in the learning curve. LDP affords carefully selected patients the benefits of laparoscopic surgery.