Introduction: Hand-assisted laparoscopic colectomy has been introduced as an alternative to the standard laparoscopic technique. However, it has not yet been established whether intra-abdominal placement of a hand abrogates the benefits of minimally invasive techniques. We hypothesized that the hand-assisted approach confers advantages of minimal access surgery over traditional open colectomy.Methods: We performed a retrospective review of consecutive patients undergoing elective open (O) and hand-assisted (HA) colon resections at a tertiary care hospital. Open colectomies performed by the laparoscopic surgeons were excluded. Outcome measures included patient demographics, operative time, perioperative complications, operative and total hospital charges, and length of stay. Statistical analysis was performed using Wilcoxon Rank Sum, Fisher’s Exact, and Student’s t-test with p <0.05 considered significant.Results: Three hundred twenty-two O and 66 HA consecutive elective colectomies were identified and reviewed. Of these, 185 (57.4%) O and 42 (63.6%) HA were left-sided. The two groups were similar in age (60.4 vs 59.1 years), sex (62.6% vs 67.1% females), and body mass index (29.9 vs 33.1 kg/m2). The mean operative time was longer in the HA group (202 vs 160 minutes, p = 0.002). There were no major intraoperative complications in either group and no conversions form HA to O colectomy. Postoperatively, no patient in the HA group and 14 (3.8%) patients in the O group required blood transfusion. Anastomotic leak rate was significantly higher in the O vs the HA group (2.8% vs 1.5%; p=0.04). The rate of wound infections was also higher in the in the O [11 (3.4%)] vs the HA [1 (1.5%)] group (p=0.04). All 7 (2.3%) mortalities occurred in the O group. The length of hospitalization was significantly shorter in the HA group (5.1 vs 11.5 days, p<0.001). Total hospital charges were significantly lower in the HA group ($24,132 vs $33,150; p<0.0001)Conclusion: Hand-assisted laparoscopic colectomy is a safe alternative to traditional open colonic resections. In this series, it was associated with a decreased postoperative morbidity and mortality. Despite longer operative times, the use of the hand-assisted techniques resulted in a significant reduction of the duration of hospitalization and decreased total hospital charges. Overall, in the elective setting, hand-assisted laparoscopic colectomies are clearly advantageous over the traditional open colectomies.