Hand-assisted approach to laparoscopic myomectomy and hysterectomy.

In this series we discuss the feasibility of hand-assisted approach to laparoscopic myomectomy and hysterectomy. The hand-assisted approach is a useful technique bridging the benefits of minimally invasive surgery and an open approach. We present the largest series to date of 15 patients: 10 hand-assisted hysterectomies and 5 myomectomies. All 15 cases were performed by the team of surgeons at a large academic medical center in the northeastern United States. We provide a detailed description of the hand-assisted technique along with patient demographic data, surgical outcomes, and complications. Operating times ranged from 86 to 269 minutes, and estimated blood loss ranged from 30 to 4000 mL. On the basis of preliminary outcomes, the hand-assisted technique appears to be beneficial in challenging laparoscopic cases, yet careful patient selection and vigilance are required to ensure successful outcomes.