The marriage of video technology with laparoscopic equipment freed surgeons' hands for manipulation of instruments and allowed assistants to simultaneously view each aspect of a procedure. This video technology, combined with advancements in laparoscopic instrumentation, allowed performance of complex intra-abdominal procedures, starting with laparoscopic cholecystectomy. As surgeons become more proficient with laparoscopic techniques and industry responds by developing more sophisticated laparoscopic instrumentation, including clipping and stapling devices, the number and types of procedures performed with the laparoscope are blossoming. Hernia repair, appendectomy, Nissen fundoplication for gastric reflux, selective vagotomy, gastrostomy and jejunostomy tube placement, adrenalectomy, bowel resection, lymph node dissection, liver biopsy, staging of intra-abdominal tumors, and splenectomy now are commonly performed. Decreased requirement for pain medication and more rapid return to full activity are often cited as the primary advantages of laparoscopic surgery, but most procedures have not been rigorously compared with their “open” counterparts. Advanced laparoscopic surgery can be challenging, and the potential exists for significant hemorrhage, which cannot be controlled with the laparoscope, and injury to other organs. These disadvantages of laparoscopic surgery are particularly relevant to removal of the spleen, a vascular organ located high in the posterior left upper quadrant.

Elective open splenectomy is a relatively low-risk procedure in healthy individuals but requires hospitalization for 3 to 7 days, significant postoperative pain medication, and 2 to 6 weeks for full recovery. However, many patients who require splenectomy have significant co-existing medical problems, neutropenia, and/or thrombocytopenia which complicate intraoperative and postoperative management. It is not currently known if laparoscopic splenectomy is safe and effective in all of these patients. Laparoscopic splenectomy is a procedure in evolution, and the guidelines set forth in this article are changing rapidly. This article summarizes the current indications for laparoscopic splenectomy, describes the technique, and reviews experience to date with the procedure.