The use of intraoperative drains in pancreatic surgery, particularly in minimally invasive pancreatoduodenectomy (MIPD), is a topic of ongoing debate. Traditionally, drains have been routinely placed after pancreatic resections to prevent complications such as postoperative pancreatic fistula (POPF), infections, and abscesses. However, recent evidence challenges the necessity of routine drainage, especially in low-risk patients. This chapter examines when and how to place drains in MIPD, focusing on patient risk stratification and surgical technique. The Fistula Risk Score (FRS) and its updated alternative version for MIPD (ua-FRS) are key tools in determining the need for drains based on individual patient characteristics and intraoperative findings. In high-risk patients, drains facilitate early detection and management of complications, while in low-risk patients, drain omission may reduce hospital stays, infection risks, and discomfort. However, selective drain placement should be carefully considered in MIPD, where the procedural complexity and technical challenges—such as limited access and altered fluid dynamics—warrant the careful positioning of drains at critical anastomotic sites. Two drains are typically recommended to cover areas at high risk for leaks, like the pancreatico-jejunostomy and hepatico-jejunostomy. In conclusion, while individualized approaches are encouraged, intraoperative drainage remains an essential component of managing postoperative complications in MIPD.