Editorial Comment Hand assisted procedures allowed less experienced laparoscopic surgeons to offer a less invasive approach to their patients with results comparable to purely laparoscopic surgery; i.e.; radical nephrectomy. Unfortunately, the causes of hand numbness and/or pain have never been completely elucidated, i.e. fascial length and compression, pneumoperitoneum, etc. Interestingly, this paper demonstrated that after 24 minutes of pneumoperitoneum (15 mm of Hg) the surgeon's hand would suffer hypoxia that may trigger symptoms of discomfort and pain. For surgeons that would occasionally perform this type of surgery may not suffer the effects of local hypoxia but for those who would routinely perform hand-assisted procedures that would last more than 24 minutes should be aware of this occupational risk and take precautions to prevent from chronic problems.
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