Surgery for the treatment of morbid obesity provides long-term relief for weight-related diseases. It is currently recognized as a safe and effective treatment for patients with a body mass index (BMI) greater than or equal to 35. The advancement of laparoscopic and video instrumentation and technology has allowed the application of minimally invasive surgical techniques to bariatric surgery. Currently, laparoscopic approaches provide a recognized advantage to surgery for obesity, and specifically the laparoscopic Roux-en-Y gastric bypass has been demonstrated to provide optimal outcomes in selected patients. However, laparoscopic bariatric surgery remains challenging. These challenges include difficulty in access, retraction, tissue manipulation, and identifying anatomic landmarks. These challenges make laparoscopic bariatric surgery difficult to learn and difficult for surgeons who lack an experienced assistant. Hand-assisted laparoscopic surgery (HALS) is an effective technique, applicable on a wide variety of advanced laparoscopic procedures (1). It provides the benefits of precise tissue manipulation, tactile feedback, blunt tissue dissection, and retraction, and it can be a valuable tool for the transition into and completion of minimally invasive bariatric surgery.
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