Simple nephrectomy: Hand-assisted technique

Chronic inflammation or prior surgical procedures may complicate the laparo scopic performance of simple nephrectomy, In these difficult cases, hand-as sisted laparoscopy may be useful. The position of the hand port depends on the particular situation, but the port must allow flexion of the wrist and access to the entire surgical field. The hand-assisted procedure is similar to standard laparoscopy in analgesic use, time to oral intake, length of s tay, and time to full recovery, Hand-assisted laparoscopy allows the inexpe rienced surgeon to perform laparoscopy with the aid of tactile sensation an d three-dimensional spatial orientation. For the experienced surgeon, the t echnique offers an alternative to open conversion when the laparoscopic pro cedure fails to progress.