Hand-assisted laparoscopic colorectal surgery.

Hand-assisted laparoscopic surgery is a newly developed technique. It involves the intraabdominal placement of a hand or forearm through a mini-laparotomy incision while pneumoperitoneum is maintained. In this way, the hand can be used as in an open procedure to palpate organs or tumors, reflect organs atraumatically, retract structures, identify vessels, dissect bluntly along a tissue plain, and provide finger pressure to bleeding points while proximal control is achieved. Additionally, this approach is more economical than a totally laparoscopic approach, reducing both the number of laparoscopic ports and number of instruments required. Some advocates of the technique claim that it is also easier to learn and perform than totally laparoscopic approaches and that it may increase patient safety.