Laparoscopic splenectomy has become the standard approach in many institutions when splenectomy is indicated for benign hematologic disease and has gained acceptance in patients with malignant hematologic disease and splenomegaly. It is a technically difficult procedure and is associated with a steep learning curve, with operative times initially longer than those associated with open splenectomy. However, technical advancements such as hand-assisted laparoscopic splenectomy have facilitated increased acceptance of laparoscopy as an approach that is superior to open splenectomy, even in patients with malignant hematologic disease and/or splenomegaly. When compared to open splenectomy, laparoscopic splenectomy is associated with shorter postoperative hospitalization and improved cosmesis.