Spleen-preserving distal pancreatectomy is a surgical option for the treatment of select pancreatic masses, such as benign disease, premalignant lesions, and early neuroendocrine tumors. Spleen preservation is associated with multiple benefits, including fewer infectious complications, decreased cost, and less intraoperative blood loss. There are two main techniques for performing a spleen-preserving distal pancreatectomy. Vessel-preserving, spleen-preserving distal pancreatectomy, also known as the Kimura technique, requires careful dissection and preservation of the splenic artery and vein. Conversely, vessel-resecting, spleen-preserving distal pancreatectomy, or the Warshaw technique, relies on collateral blood supply from the short gastric arteries after ligation of the splenic artery and vein. In this chapter, we aim to provide a comprehensive overview of the indications, preoperative preparation, operative steps, as well as the pearls and pitfalls associated with both vessel-preserving and vessel-resecting spleen-preserving distal pancreatectomy. While there is no formal consensus on the superiority of one method over the other, some data suggest increased morbidity with vessel-resection. Thus, we recommend vessel-preservation as the first-line approach, followed by vessel-resection as a bail-out maneuver.