title: Hand-assisted laparoscopic lymphadenectomy: a novel approach to a difficult area.
abstract: BACKGROUND
  Hand-assisted laparoscopic surgery (HALS) is an emerging technique that is gaining acceptance for a wide range of abdominal procedures. We drew upon our growing experience with hand-assisted laparoscopic and thoracoscopic surgery to manage a case that was felt to require a major thoracoabdominal incision if it were to be completed by conventional open surgery.
  
  
  METHODS
  A technique is described that combines the advantages of both laparoscopic and open surgery in the form of hand-assisted laparoscopic surgery to permit safe dissection of a retrocrural mass extending into the chest.
  
  
  RESULTS
  We used this technique successfully to completely resect a nodal deposit of metastatic embryonal carcinoma previously thought to be inaccessible to surgical resection.
  
  
  CONCLUSIONS
  The use of hand-assisted laparoscopic surgery improves tactile and visual feedback for the operator. This allows complex procedures involving delicate dissection to be completed safely and with less morbidity than open surgery.
authors.affiliation: Cardiothoracic Surgical Unit, University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia. a_d_sutherland@hotmail.com
authors.forename: Andrew
authors.initials: A
authors.lastname: Sutherland
authors.forename: Gavin
authors.initials: G
authors.lastname: Wright
mesh_terms: D000328:Adult; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000556:secondary* / Q000601:surgery*; D009919:Orchiectomy; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery; D014110:Touch