Selection of patients for hand-assisted laparoscopic surgery.

Each of the well-established approaches to laparoscopy-standard transperitoneal, standard retroperitoneal, and transperitoneal hand-assisted-has its advantages and disadvantages. In order to maximize efficiency and patient benefit, each approach should be used selectively. This paper offers recommendations for the selective use of the hand-assisted technique, which is particularly useful when intact specimen removal is required, the surgeon has limited experience, the situation is expected to be difficult (e.g., prior surgery, fibrosis, inflammation), or the patient's other medical comorbidities mandate a rapid procedure.