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Hand Assisted Laparoscopy

OBJECTIVES Laparoscopic surgery has not been extended enough among the urologists due to the inaccessibility of the retroperitoneal organs and consequently to the steep learning curve that is required. In this article we describe our experience in laparoscopic surgery assisted by the surgeon's hand introduced in the operating field. This is a technique that we have been using since 1994 and that has not been generally accepted until very recently. METHODS Difficult nephrectomies and nephroureterectomies are considered to be the main indications for this technique. The approach to each kidney is described. RESULTS The operating time is dramatically reduced. The surgeon's hand introduced intra-abdominally allows for a better control in difficult situations. The economic cost is lower. The use of analgesics and the recovery time in the postoperative period is similar to that of conventional laparoscopy. CONCLUSIONS The optimal indication for this procedure are cases that require a very large and mutilating incision. The learning curve is significantly easier and it is an invaluable technique in cases considered until now to be unsuitable for an endoscopic procedure.