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Reconstructive techniques performed using open, laparoscopic, or hand-assisted techniques depend on the surgeon's ability to approximate tissues and secure bleeding vessels safely and efficiently. The indications for hand-assisted suturing include hemostasis, diaphragmatic and visceral repair, and reconstruction. The equipment required includes a standard laparoscopic needle driver, sutures with noncutting needles, and the handaccess device. The surgeon should be comfortable with the particular equipment available in his/her operating room. Techniques for suturing during hand-assisted laparoscopic reconstructive surgery are described.