Hand-assisted laparoscopy for pelvic malignancy

The inability to palpate intra-abdominal organs is a barrier to the widespread utilization of laparoscopy in the management of pelvic malignancy. Hand-assisted laparoscopy permits the insertion of the hand into the abdomen through a glove-sized incision while preserving the pneumoperitoneum. This new modality preserves both the technical benefits of traditional manual assistance and the convalescent advantages of minimally invasive surgery. Our preliminary experience suggests that this approach is a feasible, safe, and expeditious access option that can effectively replace an extended open laparotomy incision or an excessively tedious laparoscopic exercise in the evaluation and management of pelvic malignancy. Moreover, oncologic surgeons, reluctant to relinquish the tactile advantages of open surgery, may find hand-assisted laparoscopy an appealing alternative.