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Purpose: We present our experiences of pancreatic insulinoma among the functioning neuroendocrine neoplasm of the pancreas, to review the natural history and suggest proper management. Methods: From June 1990 to August 2006, patients with diagnosis of pancreatic insulinoma were retrospectively reviewed. Results: Thirteen patients (5 men and 8 women) with median age of 42 years (range, 12~68 years) were investigated. One patient (12%) with pancreatic insulinoma was MEN 1. Intraoperative ultrasound scan (sensitivity, 88%) was the most powerful modality for tumor localization. Sixteen neoplasms with median tumor size 1 cm (range, 0~3 cm) were found. Ten neoplasm (62%) were located in the heads/ necks of the pancreas. Six neoplasm (38%) were located in the tails. Five neoplasm (31%) were located around the neck areas near the SMV or PV. Twelve patients (92%) underwent enucleation, and two patients (15%) underwent distal pancreatectomy with splenectomy. 100% of patients with pancreatic insulinoma have survived and the overall disease free 10-year survival was found to be about 85.7%. Conclusion: Exact localization of tumor by intraoperative ultrasound and effective surgical removal can be significantly beneficial for good prognosis. (J Korean Surg Soc 2007; 72:128-132)