Though the use of laparoscopy in the management of abdominal trauma is rapidly increasing, this modality should be used with caution. In hemodynamically stable patients, the main advantage of laparoscopy is in preventing a nontherapeutic laparotomy, especially when the CT is equivocal. However, the most important concern is about missed injury. Apart from screening and diagnostic purposes, laparoscopy is also being used for therapeutic purposes, especially in repair of the diaphragm and bowel in patients with penetrating injuries. Contraindications include hemodynamic instability, head injury, and settings without immediate equipment availability. Diffuse peritonitis and the experience of the surgeon are considered relative contraindications. It has been claimed that a busy general surgeon with technical skills for efficient laparoscopic suturing and good experience of working in confined spaces would be the ideal trauma surgeon performing these surgeries. The principles of exploration in case of blunt and penetrating trauma injuries are a bit different, the trajectory of the wound being an important guide in penetrating trauma. The rate of conversion to an exploratory laparotomy is reported to be 7–45%, mostly due to hemodynamic instability, intraoperative hemorrhage, and suboptimal visualization. The literature regarding trauma laparoscopy is sparse and limited to single center series from large trauma centers. The only randomized controlled trial (RCT) dates back to 2003 which concluded that in penetrating trauma abdomen with a definite peritoneal breach, laparoscopy has only a minimal benefit over laparotomy. However, in the last two decades with the advancement of minimal invasive techniques and better radiological evaluation, laparoscopy is gaining more momentum and acceptance. Although there are no new RCTs, a few meta-analyses have been published, and all these favor laparoscopy over laparotomy due to its faster recovery rates and lower postoperative complications. In the hands of a trained trauma surgeon, the results of trauma laparoscopy are good, especially when it is done for the correct indication.