Laparoscopic splenectomy is easiest for small spleens (for example, the normal sized spleen associated with idiopathic thrombocytopenic purpura [ITP]). Techniques have been developed for moderate to large sized spleens, but in general, the larger the spleen the more difficult the surgery. The first laparoscopic splenectomies were performed with the patient supine, in a manner similar to that used during open splenectomy. The technique described here, in which the patient is placed in the lateral position and the peritoneal attachments of the spleen are used to suspend it in place is sometimes termed the “hanging spleen” technique. References at the end give details of other techniques and modifications for large spleens, as well as techniques for partial splenectomy and excision of splenic cysts.