OBJECTIVE: Although hand-assisted laparoscopic surgery (HALS) has been utilized in abdominal surgery, limited data exist on the feasibility and safety of HALS in the evaluation of pelvic masses. Our goal was to compare HALS to conventional laparotomy for pelvic masses in gynecologic patients. METHODS: A chart review identified patients who underwent a HALS or XLAP procedure for the evaluation of a pelvic mass from January 2003 to September 2004. RESULTS: 70 patients were analyzed-29 cases (HALS) and 41 controls (XLAP). The groups were comparable in terms of age (48 vs. 49 years), body mass index (29.1 vs. 29.8 m2), and mass size (11.0 vs. 11.3 cm). Operative times were similar between the groups (90 vs. 72 min, P = 0.9). HALS was associated with decreased estimated blood loss (108 vs. 207 cm3, P = 0.004), shorter hospital stay (2.8 vs. 4.2 days, P = 0.03), and fewer post-operative complications (4 vs. 11, P = 0.05). CONCLUSIONS: HALS is a safe and feasible alternative to conventional open laparotomy for the evaluation and surgical treatment of pelvic masses. In addition to similar operative times, HALS demonstrated a decreased estimated blood loss, complication rate, and length of hospital stay.