Hand assisted laparoscopic removal of large retroperitoneal lipomas – a simple technical innovation

This series of 3 Retroperitoneal laparoscopic excisions using the alternating hands of the surgeonsintroduced through Pfannenstiel incision to facilitate traction, retraction and dissection in the surgery of these complex tumors is published to highlight the use of the specimen extraction incision. As these large solid tumors need to be removed through incisions a few inches long, we have used the incisions to insert a hand and facilitate the surgery. Also, a small Pfannenstiel will not affect the post-operative respiratory function as would a large midline or lateral incision. Perhaps in the future, hybrid procedures combining the hand and laparoscope would dominate over either procedure alone.