The Surgical Technique of Hand-Assisted Laparoscopic Sigmoid Colectomy

Although the first reported laparoscopic assisted colectomy was in 1991 [1], the number of laparoscopic colonic procedures remained a minority of colonic resections. This was attributed to the fact that laparoscopic colectomy is technically challenging and demands a long learning curve. Therefore, hand-assisted laparoscopic surgery (HALS) was advocated as a useful alternative to laparoscopic colonic surgery and was introduced as a hybrid technique that allows the introduction of the surgeon's nondominant hand into the abdomen through a special hand port while maintaining pneumo peritoneum [2]. This permits laparoscopic visualization, assists in dissection, retraction and placement of laparoscopic instruments. In this respect, HALS combines the advantages of open surgery-with the surgeon's non-dominant hand inside the abdomen-and those of minimally invasive techniques. A hand inside the abdomen does restore the tactile feedback sensation-which is lacking in laparoscopic surgery-, allows safe finger dissection and retraction, and improves hand-eye coordination. All those factors may play an important part in reducing the operative time [3].