STATIONARY MECHANICAL-ASSIST TECHNOLOGY FOR SINGLE-SURGEON LAPAROSCOPIC BILATERAL VARICOCELECTOMY

One potential detraction from the continued application of laparoscopy in the management of varicoceles is the requirement for a skilled ass istant, which increases the cost of performing this surgery. This repo rt describes the clinical application of a simple stationary mechanica l-assist device to allow a single surgeon to perform bilateral varicoc electomies. The device is attached to the surgical table with a rotary adjusting stemarm. A cross-mounted sidearm stretches over the patient and forms the attachment to friction-jointed elbow and wrist attachme nt to the laparoscope, providing the range of motions similar to a hum an arm (shoulder, elbow, wrist). By adjusting the tension at all three levels, changes of the laparoscopic camera portal are possible. Both of the surgeon's hands are then free to work through two operating tro cars. The Laprotract arm (Minnesota Scientific, St. Paul, MN) cost $30 00 and is autoclavable for quick reutilization. The average time neede d to set up the device for bilateral varicocelectomy during eight case s was 2 minutes. The mean procedure time was 65.0 (+/-23.1) minutes, r eflecting its ease of use. The electronic image obtained from the stat ionary mechanical assistant was always steady, and there was no inadve rtent wandering from the surgical field. Statistical comparison with 6 3 open left and 22 open bilateral varicocelectomies during the same ti me period demonstrated no significant differences in the procedural ti mes. Mechanical-assist technologies can facilitate laparoscopic bilate ral varicocelectomies, allowing a single surgeon to perform this opera tion as quickly as left and bilateral open procedures.