Hand-assisted laparoscopic surgery (HALS) with the HandPort System - Initial experience with 68 patients

Objective To evaluate the feasibility and potential benefits of hand-assisted laparos copic 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 1 0 laparoscopic surgical centers. Surgeons were free to test the device in a ny situation where they expected a potential advantage over conventional la paroscopy. Results Sixty-eight patients were entered in the study. Operations included colorec tal procedures (sigmoidectomy, right colectomy, resection rectopexy), splen ectomy 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 t o insert their nondominant hand into the abdomen. Pneumoperitoneum was gene rally maintained at 14 mmHg, and only one patient required conversion to op en surgery as a result of an unmanageable air leak. Hand fatigue during sur gery was noted in 20.6%. Conclusions The hand-assisted technique appeared to be useful in minimally invasive col orectal surgery, splenectomy for splenomegaly living-related donor nephrect omy, and procedures considered too complex for a laparoscopic approach. Thi s approach provides excellent means to explore, to retract safely, and to a pply immediate hemostasis when needed. Although the data presented here ref lect the authors' initial experience, they compare favorably with series of similar procedures performed purely laparoscopically.