Preoperative diagnosis of pancreatic diseases is very challenging due to the organ's inaccessibility using existing endoscopic methods. Laparoscopic examination of the pancreas has become possible through the thin layer of the lesser omentum, and instrumental palpation and biopsy are performed by dissecting the lesser and greater omentums. This method has not gained widespread acceptance and is used only in a few clinics. Applied anatomy. The pancreas is located at the junction of the abdominal cavity and the retroperitoneal space. It is anatomically connected to the retroperitoneal organs and vessels, while the organs (stomach and intestine) located anterior to the gland are only adjacent to it and are covered by them and ligaments. This latter condition determined the possibility of examining the pancreas from the lesser and greater omentum. The cavity of the lesser omentum is divided by peritoneal folds, which extend to the gland from adjacent organs and serve as a natural barrier to simultaneous examination of all sections of the gland. Equipment. For pancreatoscopy, surgical laparoscopes with end-type optics are used. They have channels for the introduction of flexible and rigid instruments and reduce the number of punctures of the anterior abdominal wall. Viewing laparoscopes can also be used, but then it is necessary to introduce additional instruments through new punctures of the anterior abdominal wall using trocars with a diameter of 3-5 mm. Instruments: soft forceps for grasping and retracting the stomach and omental tissue, scissors for dissecting the omentum in the avascular area, biopsy forceps and needles for instrumental palpation and biopsy of the glandular tissue. If equipped with an electrically insulating coating, these instruments can serve as monopolar electrodes for working in the cutting and coagulating current mode. Indications and contraindications. Laparoscopic pancreatoscopy can be performed if malignant lesions of the pancreas are suspected, which cannot be excluded by other methods; if indirect visual signs of a pancreatic tumor are detected during laparoscopy; For performing a targeted biopsy of the pancreas. Contraindications: the presence of adhesions in the upper abdomen and the lesser omentum, significant fatty deposits in the greater omentum, and insufficient technical equipment. Patient preparation, premedication, and anesthesia are necessary. In addition to standard preparations, large doses of antienzyme drugs (e.g., 500,000 IU of trasylol) are administered immediately before laparoscopic pancreatoscopy. Technique: There are several types of pancreatoscopy. Supragastric pancreatoscopy without damaging the omentum is possible if the lesser omentum has minor fatty deposits and appears as a thin, transparent sheet. The laparoscope is inserted into the abdominal cavity at a point located 3 cm above the umbilicus and 3 cm to the left of the midline. With the patient positioned on the right side with the head of the table elevated, which displaces the stomach downwards along with the greater omentum, the laparoscope is inserted under the left lobe of the liver and lifted. Part of the head and body of the pancreas is examined through the freed lesser omentum. To palpate the pancreas, an additional trocar and special manipulators are inserted through the lesser omentum into the abdominal cavity above and to the right of the laparoscope. For supragastric pancreatoscopy with perforation of the lesser omentum and direct examination of the pancreas, an operating laparoscope is used. Two forceps are inserted through its channels, grasping and perforating the lesser omentum tissue. Another laparoscope is inserted through the resulting opening into the lesser omentum cavity, which is used to examine part of the body and tail of the pancreas. For pancreatoscopy with a viewing laparoscope, two forceps are inserted into the abdominal cavity in the left upper quadrant through separate punctures in the anterior abdominal wall. The lesser omentum is perforated. The laparoscope is passed through the resulting opening, and the body and tail of the gland are examined. Infragastric pancreatoscoliosis. The trocar with the laparoscope is inserted at a point located 3-4 cm below the left costal margin and 2 cm to the left of the midline. A 5 mm diameter trocar with forceps is inserted at a point 1-2 cm above the umbilicus on the left, and the gastrocolic ligament is retracted. A third 5 mm diameter trocar with forceps is inserted at a point 1 cm above the laparoscope, and the gastrocolic ligament is retracted. A monopolar coagulator inserted through the laparoscope channel is used to cauterize the gastrocolic ligament in the avascular zone for 1.5-2 cm. The laparoscope is then inserted through this opening into the lesser omentum cavity, where the pancreas is examined. This technique allows for examination of a significant portion of the body and tail of the pancreas. If a pancreatic tumor is suspected, a pancreatic biopsy using biopsy forceps and needles is indicated. The biopsy is performed in 2-3 areas of the gland. Following the biopsy, up to 500,000 units of Trasylol are injected into the lesser omentum cavity to prevent acute pancreatitis. Complications. Laparoscopic pancreatoscopy and pancreatic biopsy carry the risk of bleeding, pancreatitis, fistulas, and other complications, although the incidence is low.