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Background: Laparoscopic left-sided pancreatectomy is becoming an important alternative for patients with pancreatic tumors. Comparative data on laparoscopic left sided pancreatectomy (DP) compared to laparoscopic spleen preserving left sided pancreatectomy (DP-SP) is limited.Methods: Patients undergoing a left-sided pancreatectomy by a single surgeon from 2001-2009 were entered into this study. The pancreatectomy was performed using a laparoscopic assisted approach with the Gelport as a hand access device. DP-SP and DP cohorts were compared for clinical outcome (age, blood loss, LOS, transfusion, pancreatic fistulae, complications, time to ingestion of an oral solid and liquid diet) and extent of oncologic resection (amount of pancreas removed, size of tumor, number of nodes retrieved, margin status, extent of soft tissue resected). Univariate and multivariate analysis (binary logistic regression) was performed on the two groups using SPSS (version 18). Results shown as DP vs DP-SP.Results: 106 patient underwent intent to treat and in 102 the procedure was completed laparoscopically (conversion 4.8%). 69 patients underwent DP and 33 DP-SP. Mean age (62.2 vs 49.3y), ASA (2.6 vs 2.3), BMI (28 vs 27), blood loss (263.2 vs 227.4cc), transfusion (0.18 vs 0.21 units), clear liquid ingestion(1.2 vs 0.6d) and postoperative complication (Clavien grade 0.45 vs 0.45) were not significant on univariate analysis (p > 0.05). Mean time to solid ingestion (2.82 vs 2.0d), LOS (4.26 vs 2.94d) and pancreatic fistula (ISGPF grade 0.26 vs. 0.48) was significant on univariate (p < 0.05) but not on multivariate analysis. Mean tumor diameter (4.5 vs 2.6 cm), and number nodes retrieved (20.3 vs 3.7) was significant on univariate analysis (p < 0.05) and only nodes retrieved was significant for DP on multivariate analysis (p < 0.005, odds ratio 1.4, 95% confidence interval 1.13-1.7). Positive margins (3% vs. 1%) and pancreas length (9.0 vs 6.8 cm) was not significant (p > 0.05). There was no mortality in this study.Conclusions: In this largest single surgeon experience we show that laparoscopically assisted DP and DP-SP have similar clinical outcomes and both procedures are associated with a low morbidity. Extent of soft tissue and nodal resection was significantly greater in the DP group. Laparoscopic-assisted spleen preserving distal pancreatectomy is a safe operation that should be reserved for patients with benign tumors. In patients in whom a malignancy suspected a laparoscopic distal pancreatomy should be performed.