Hand-assisted laparoscopic colectomy techniques.

Laparoscopic colon and rectal surgery has gained popularity over the last 10 years. The experience obtained from the more simple surgeries, such as cholecystectomy and appendectomy, and the development of better instruments have made colorectal standard laparoscopic surgery an easier procedure. However, the downside associated with this technique includes longer operative times, higher costs, loss of tactile sensation, and a two-dimensional view. In the last 5 years, a new type of instrument has appeared on the market: the hand-assist device. It gives back the tactile feeling and allows the surgeon to retrieve a three-dimensional evaluation of the abdomen. This instrument has changed the laparoscopic surgery field and permitted the expansion of laparoscopic colectomy to the most challenging and complex cases. Hand-assisted laparoscopic surgery seems to retain the same benefits as standard laparoscopic surgery and improve the operative time and the learning curve. This article reviews the benefits and the indications for the use of the hand-assist device, and the characteristics and types of hand-assist devices available and their instruction for use. It also focuses on the technical aspects of hand-assisted laparoscopic surgery.