Hand-assisted laparoscopic surgery in the United States: an overview.

Hand-assisted laparoscopic surgery (HALS) was developed to bridge the gap between open surgery and advanced laparoscopic surgery. Advantages of the hand in the abdomen include tactile feedback, the ability to palpate, blunt dissection, organ retraction, control of bleeding, and rapid organ removal. There are 3 commercially available devices in the United States, as well as a fourth in Europe and a fifth in Japan. Uses for HALS include procedures requiring intact specimen removal, complex laparoscopic procedures, preventing open conversion, and overcoming a technical obstacle. HALS procedures, such as esophagectomy, gastrectomy, hepatectomy, pancreatectomy, splenectomy, bariatric surgery, colectomy, nephrectomy, hysterectomy, and aortobifemoral bypass, have all been reported in the literature. Improvement in instrumentation, specifically with newer generation devices, will allow HALS to become more popular. We advocate the use of HALS specifically for laparoscopic colectomy, laparoscopic splenectomy for massive splenomegaly, and for living-related donor nephrectomy.