The benefits of laparoscopic techniques in colon and rectal surgery have been extensively reported and include a reduction in hospital stay, postoperative pain, and narcotic requirements with improvements in gastrointestinal function. A reduction in postoperative convalescence, improved cosmesis, reduction in postoperative wound complications, and decrease in adhesion formation have also been reported as advantages of laparoscopic approach (1,2,3,4,5).

Often the largest incision in laparoscopic colon and rectal procedures is usually dictated by the size of the specimen being removed, or the extraction site. In straight laparoscopic or laparoscopic-assisted methods, the extraction site, which often measures from 3 to 10 cm is often performed after a substantial amount of time and effort, has been expended in identifying vital structures, dissecting soft tissue planes, isolation and ligation of mesenteric vessels, and transaction of bowel wall. Often this approach seems counter-intuitive, in that a surgeon would spend a significant amount of time and effort to perform a minimally invasive laparoscopic colon and/or rectal resection and then at the end of the case to create a much larger incision for an extraction site in order to complete the procedure. Excluded from this discussion are those surgeons who perform laparoscopic colon and rectal resections via a transrectal or transvaginal extraction site. The utility and adoption of these natural orifice extraction sites are still in progress and will need some time to mature.

Hand-assisted laparoscopic surgery (HALS) is a method in which the surgeon is able to place an entire hand at times during the operation into the abdomen through a specially designed hand-assisted device or port while maintaining pneumoperitoneum. The benefit of HALS is that the extraction site can be used from the outset of the operation and will allow the return of tactile sensation, improved spatial relationships, allows for rapid exploration of the abdomen, enabling palpation of intra-abdominal organs and masses, offers excellent assistance with retraction and nontraumatic retraction
of tissue planes, and blunt finger dissection. Introduction of the hand-assisted method can assist in dealing with a hostile abdomen with inflammatory processes or patients with extensive adhesions; in addition, it can allow for rapid control of hemorrhage and may overall allow laparoscopic completion of a procedure that otherwise would be converted (6,7,8,9,10,11,12,13

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