Insulinomas are the most common islet cell tumors and are located almost exclusively in the pancreas. Most of these tumors are sporadic, but they may also be associated with the multiple endocrine neoplasia type I syndrome. More than 90% of insulinomas are benign. Preoperative radiographic localization may prove difficult. Intraoperative palpation and ultrasound remain the gold standard for detection and appropriately planned resection. Although many options are available to treat the patient with malignant and metastatic disease, the mainstay of treatment remains surgery. Laparoscopic ultrasound and enucleation/resection may be increasingly used in the management of patients with insulinoma.