Objective: To evaluate the feasibility and potential benefits of hand-assisted laparoscopic surgery with the HandPort System, a new device.
Summary Background Data: In hand-assisted laparoscopic surgery, the surgeon inserts a hand into the abdomen while pneumoperitoneum is maintained. The hand assists laparoscopic instruments and is helpful in complex laparoscopic cases.
Methods: A prospective nonrandomized study was initiated with the participation of 10 laparoscopic surgical centers. Surgeons were free to test the device in any situation where they expected a potential advantage over conventional laparoscopy.
Results: Sixty-eight patients were entered in the study. Operations included colorectal procedures (sigmoidectomy, right colectomy, resection rectopexy), splenectomy for splenomegaly, living-related donor nephrectomy, gastric banding for morbid obesity, partial gastrectomy, and various other procedures. Mean incision size for the HandPort was 7.4 cm. Most surgeons (78%) preferred to insert their nondominant hand into the abdomen. Pneumoperitoneum was generally maintained at 14 mmHg, and only one patient required conversion to open surgery as a result of an unmanageable air leak. Hand fatigue during surgery was noted in 20.6%.
Conclusions: The hand-assisted technique appeared to be useful in minimally invasive colorectal surgery, splenectomy for splenomegaly, living-related donor nephrectomy, and procedures considered too complex for a laparoscopic approach. This approach provides excellent means to explore, to retract safely, and to apply immediate hemostasis when needed. Although the data presented here reflect the authors' initial experience, they compare favorably with series of similar procedures performed purely laparoscopically.
In hand-assisted laparoscopic surgery (HALS), a recent development, the surgeon inserts a hand into the abdomen while pneumoperitoneum is maintained and uses the hand to assist the laparoscopic instruments directly. The approach of using an incision from the very beginning of the operation, which would be created to assist in the extraction of a resected specimen at some point during the procedure, seems logical, especially in the context of advanced laparoscopic procedures. It has been demonstrated that most major surgical procedures are amenable to the laparoscopic approach. However, advanced laparoscopic procedures have not been adopted for a number of reasons. They often take much longer then conventional surgery, rendering the cost/benefit ratio questionable. 1-4 This partly reflects the technical difficulties, lack of training and experience, and limited instrumentation available for advanced laparoscopic surgery, as well as the lack of tactile feedback and the absence of depth perception on the two-dimensional video monitor.
The appearance of hand-assist devices in the mid-1990s raised great expectations in the laparoscopic community. The presence of an assisting hand can provide tactile feedback. Gentle blunt dissection and hand-assisted retraction during advanced laparoscopic procedures may help solve these problems. However, because a 7- to 8-cm incision is required to accommodate the surgeon's hand, some of the benefits of minimal access surgery (reduced postoperative pain, faster recovery, shorter hospital stay) are expected to be lost. Although initial reports of HALS suggested potential usefulness in certain applications, 5-10 many laparoscopic surgeons were discouraged by their initial experience with early prototypes of hand-assist devices. 11
The HandPort System (Smith and Nephew Inc., Endoscopy Division, Andover, MA), a new hand-assist device developed in collaboration with the Department of Surgery at the University of Massachusetts Medical School, was designed with special attention to ease of use, reliable maintenance of pneumoperitoneum, and hand comfort. The purpose of this study was to test the HandPort System and the potential applications of HALS in a feasibility study by a group of expert laparoscopic surgeons, The HALS Study Group.