The presence of a massively enlarged spleen is commonly a deterrent to its removal by the laparoscopic approach. The causes are multiple and include difficult manipulation, encroachment on the field, extraction problems and bleeding tendency, particularly in portal hypertension patients. The use of open technique for these patients denies them the known advantages of laparoscopy.The introduction of a surgeon’s hand in the abdomen solves these problems. This is a thesis presentation that shows the technique of hand-assisted laparoscopic splenectomy for such patients. It also demonstrates how it overcomes the aforementioned obstacles.