Hand-assisted laparoscopic solid-organ surgery

Hand-assisted laparoscopic surgery has been recently introduced into the ar senal of minimally-invasive surgeons. A hand-assist device: (Dexterity Pneu moSleeven(TM), Filling Week Co., Raleigh, NC) was used to assist in four pa tients undergoing laparoscopic solid-organ surgery. Indications for operati on included 1) spherocytosis and symptomatic cholelithiasis; 2) ITP; 3) phe ochromocytoma; and 4) insulinoma. Hand-assisted procedures performed includ ed 1) splenectomy and cholecystectomy; 2) splenectomy; 3) adrenalectomy; an d 4) enucleation of insulinoma in the head of the pancreas. One patient req uired conversion to laparotomy because of failure to identify the insulinom a despite localization by hand palpation. No complications were encountered , and average hospital stay was 4.5 days. Solid-organ laparoscopic surgery may benefit from hand-assisted devices. Specific indications may include 1) small tumors that require localization by hand; 2) complex dissection requ iring hand dexterity due to size or difficulty in exposure; and 3) specimen s that:require enlargement of skin ports for removal.