Insulinomas are the most common functioning pancreatic neuroendocrine tumors (pNETs). Surgical excision is the preferred therapy, and medical treatment with diazoxide or octreotide is typically reserved for those who are poor surgical candidates. A recent emergence of minimally invasive treatment modalities has led to reports of successful radiofrequency and ethanol ablation of insulinomas. We report the first use of microwave ablation for treatment of an insulinoma in a patient with medical comorbidities contraindicating surgery.