Laparoscopy for malignancy: the role of handoscopy

In the last decade, laparoscopic surgery has revolutionized the practice of surgery to a great extent. Experienced laparoscopic surgeons have acquired proficiency for advanced procedures; however, complex laparoscopic procedures are still unpopular due to the high technical demand. Hand-assisted laparoscopic surgery or handoscopy has been developed as an adjunct to conventional laparoscopy, but its role for the management of malignancy is controversial. This technique allows the surgeon to insert a hand into the body cavities via a glovesize skin incision, while maintaining the pneumoperitoneum. The hand insertion allows tactile sensation, assists in atraumatic retraction and blunt dissection, and helps safeguard vascular control. The hand-assisted device also provides wound protection and allows intact specimen retrieval. Its applications in various oncologic procedures have demonstrated feasibility and even better recovery in some selected procedures compared with laparotomy. It may also help to reduce conversions. Handoscopic procedures allow a shorter learning curve and operative time, thereby attracting more surgeons to attempt advanced laparoscopic operations. Thus, in a selected group of complicated procedures, handoscopy provides an alternative to laparoscopy and the traditional open approach in the management of malignancy.