Insulinomas are being diagnosed with increasing frequency by biochemical investigations prior to detection by standard radiographic techniques. With these small tumors, intraoperative ultrasonic investigation has proved useful. The CUSA (ultrasonic surgical aspirator) is another new and useful device for enucleation of pancreatic tumors. In this video, we review the diagnostic techniques available for preoperative investigation of insulinoma, demonstrate the use of intraoperative ultrasound and a technique for enucleation of a small tumor located in the head of the pancreas.