The use of mechanical circulatory support devices as a bridge to transplant or destination therapy decreases mortality, improves quality of life, and functional status. The paucity of clinical data and the challenges faced by noncardiac anesthesiologists warrant us to present the perioperative care of a patient with a HeartMate II (Thoratec Corp. Pleasanton, CA, USA) left ventricular assist device (LVAD), who underwent a successful major laparoscopic abdominal surgery. Key issues highlighted are the limitations of oxygen saturation (SpO 2 ) monitoring, accuracy of blood pressure (BP) measurement, and the potential usefulness of intraoperative transesophageal echocardiography (TEE). The hemodynamic changes, impact on the LVAD function during laparoscopic surgery, and the multidisciplinary approach are addressed.