Middle pancreatectomy is parenchyma- and adjacent organ-sparing pancreatectomy indicated for small tumors located in the body, but deeply located in the gland, and therefore hard to enucleate. Others lesions including pancreatic trauma or arteriovenous malformation are also candidate targets. Invasive ductal carcinoma, even when the tumor is small enough, is not eligible because the most of these tumors show extrapancreatic invasion. After exposure of neck to body of the pancreas, middle pancreatectomy was performed by proximal and distal transection, reconstruction after Roux-Y pancreaticojejunostomy, which is the most common. This procedure is low-invasive and allow the preservation of exocrine and endocrine pancreatic function without loss of duodenal passage, however, it also has a high morbidity associated with pancreatic fistula. This article provides indications and surgical techniques with special focus on the procedure of middle pancreatectomy.