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BACKGROUND: Minimally invasive surgical approaches are increasingly applied to patients with necrotizing pancreatitis. Early experience with these approaches at our high volume pancreatic referral center was reviewed. METHODS: With IRB approval, medical records of patients undergoing minimally invasive surgical pancreatic debridement between 2007 and 2010 were reviewed. Data were collected for descriptive analysis.RESULTS: Fourteen patients were approached with minimally invasive surgical techniques: 3 retroperitoneal (VARD); 3 laparoscopic transabdominal; and 9 laparoscopic transgastric. Pancreatitis etiologies were: biliary (n=8), pancreas divisum (2), alcohol, IPMN, and idiopathic (1 each). Median time from initial pancreatitis to intervention was 10 weeks (range 6-32 weeks). Five patients had preoperative infected necrosis; 5 had preoperative percutaneous drains. Nine patients were admitted from home for elective débridement. Four patients (all laparoscopic transgastric) were converted to open operations. Four patients required early (< 30 day) reoperation: 3 for recurrent peripancreatic collections, 1 for cholecystectomy/jejunostomy. Two patients required late (>1 year) reoperation for recurrent pancreatitis and a disconnected left pancreatic remnant. Eleven patients had infected necrosis. In the 10 patients completed using a minimally invasive technique, the median length of hospital stay was 5 days (range 1-103 days); 8 were discharged to home and 2 to nursing homes. CONCLUSIONS: Good outcomes following minimally invasive pancreatic débridement can be achieved in select patients. Disease heterogeneity influences patient selection, and long-term follow-up is essential in these complex patients.