The patient is a 75-year-old male who originally presented to the hematology clinic after outpatient CBC showed thrombocytopenia and monocytosis. Peripheral blood flow cytometry confirmed hairy cell leukemia. Despite medical treatment, the patient developed persistent left upper quadrant fullness and early satiety with increasing splenomegaly. Bone marrow biopsy showed 30% involvement by hair cells, suggesting sufficient bone marrow reserve to tolerate splenectomy. He was consented for laparoscopic splenectomy with possible conversion to open laparotomy. He received the appropriate vaccinations preoperatively. A Hassan cutdown was performed to gain access to the peritoneum and ports were placed. Adhesions from prior surgeries were lysed. The spleen was significantly enlarged, taking up a majority of the peritoneal cavity, however, a majority of the splenic attachments and the splenic hilum were able to be taken laparoscopically. A hand port was placed to facilitate lysis of the final splenic attachments. The spleen was morcellated for removal. The patient tolerated the procedure well and was discharged on postoperative day two without complication. He was incidentally readmitted for two days on postoperative day 16 for bleeding duodenal ulcers, which were treated expeditiously and endoscopically without further sequelae. In conclusion, laparoscopic hand-assisted splenectomy is a viable operative option for severe splenomegaly, even in the setting of multiple prior abdominal operations.