HALS devices and operating room set-up: pearls and pitfalls

Although some surgeons maintain that such devices are not necessary, most prefer a hand-assist device for the performance of hand-assisted laparoscopy. The three devices now available are the Gelport, LapDisc, and Omniport. None is perfect, and the choice depends in part on surgeon preference and patient body habitus. Each has advantages and disadvantages, and there is room for improvement, especially in the ease of hand removal and reinsertion, sturdiness and reliability, and ability to maintain the pneumoperitoneum. Beginning laparoscopic surgeons are advised to try all three devices and formulate their own opinions. As important as the hand-assist device is the operating room set-up. The authors provide a checklist covering the imaging system, insufflation equipment, hemostatic generators, and instrumentation.