ABSTRACT

A decade has past since the first reports of successful laparoscopic nephrectomy by Clayman and colleagues in 1991 (1). During this time, indications for laparoscopic surgery within the genitourinary tract have rapidly expanded from extirpative surgeries such as pelvic lymphadenectomy, simple and radical nephrectomy, nephroureterectomy, and donor nephrectomy to more complex reconstructive procedures such as pyeloplasty, radical prostatectomy, and radical cystoprostatectomy with diversion. As the complexity of the surgeries

has increased, so have the technical demands on the surgeon, reflected by the long operative times and steep learning curve commonly associated with these procedures. Until recently, the routine delivery of advanced laparoscopic procedures has remained part of the armamentarium of only a relatively small number of urologists who possess the necessary laparoscopic expertise and experience to successfully accomplish these challenging tasks. This has left many urologists searching for ways of acquiring the necessary skills to provide their patients with state-of-the-art, minimally invasive surgery. Hand-assisted laparoscopy (HAL) has succeeded to this end, by shortening the learning curve for inexperienced laparoscopists, as well as helping those already versed in laparoscopy to accomplish even the most challenging of surgical procedures.