One of the main indications for pancreatic surgery in dogs is excision of insulinomas. To improve laparoscopic access to the pancreas, a flank approach in sternal recumbence was developed. Feasibility of laparoscopic distal pancreatectomy through a lateral flank approach in sternal recumbence was evaluated in canine patients with insulinoma. In this lecture, surgical anatomy, technique, and clinical cases will be presented of the three laparoscopic approaches to the canine pancreas.