Modified device-free HAL: an innovative cost-reductive approach.

Hand-assisted laparoscopy (HAL) has been in vogue since 1994. The major advantages are tactile sensation, quicker dissection, and easy removal of specimen. These advantages could not be availed in developing countries due to the cost of the available HAL devices. This has initiated the use of HAL without devices in our unit. Instead of a device, a double glove with a sponge between the inner and outer glove at the wrist acted as an obturating cuff. A muscle-splitting incision in the iliac fossa helped in minimizing the air leak. In this article, we report our experience in nephrectomy and nephroureterectomy.