Kirk Ludwig's operating room is bathed in twilight, rather than lit by the brilliant surgical lamp expected in such an arena. His voice is similarly subdued as he issues quiet, precise orders to the resident and nurses who aid him. And rather than poring over a large incision in their patient, they scrutinize video screens suspended above them as they carry out their delicate manipulations.

Those screens show where the real surgical action is—within the patient's abdomen, where a well-lit laparoscopic camera captures an image of shifting, glistening coils of pinkish intestines. As with usual laparoscopic procedures, the surgeons had inserted the camera's thin tube through a small incision in the patient's abdomen. And through another incision, they introduce any of a suite of laparoscopic instruments—ranging from a simple scissors to a sophisticated "bipolar cautery" that simultaneously cuts and coagulates vessels.

But surprisingly, another essential instrument appears in the camera's view—the deft hand of a surgeon. Ludwig has reached through a rubber cuff in yet a third small incision, using his gloved
fingers to manipulate the bulky intestines into position. This "hand-assist" enables him to more efficiently find and excise such targets as the gnarled, black tissue of a colon tumor.