In hand-assisted laparoscopic surgery (HALS), a recent development, the surgeon inserts a hand into the abdomen while pneumoperitoneum is maintained and uses the hand to assist the laparoscopic instruments directly. The approach of using an incision from the very beginning of the operation, which would be created to assist in the extraction of a resected specimen at some point during the procedure, seems logical, especially in the context of advanced laparoscopic procedures. It has been demonstrated that most major surgical procedures are amenable to the laparoscopic approach. However, advanced laparoscopic procedures have not been adopted for a number of reasons. They often take much longer then conventional surgery, rendering the cost/benefit ratio questionable. 1–4 This partly reflects the technical difficulties, lack of training and experience, and limited instrumentation available for advanced laparoscopic surgery, as well as the lack of tactile feedback and the absence of depth perception on the two-dimensional video monitor.

The appearance of hand-assist devices in the mid-1990s raised great expectations in the laparoscopic community. The presence of an assisting hand can provide tactile feedback. Gentle blunt dissection and hand-assisted retraction during advanced laparoscopic procedures may help solve these problems.