A 54-year-old woman was referred from hematology with a 5-year history of idiopathic thrombocytopenic purpura (ITP). Her platelet count had been as low as 2,000 and was requiring high dose steroids (prednisone, 60mg per day) to maintain her platelet count. At the time of referral her platelets were 160,000. The patient was taken to the operating room for laparoscopic splenectomy. The patient was positioned on a beanbag with her shoulders rotated to the right.