Technical advances in laparoscopy: Hand assistance, retractors, and the pneumodissector

Technology is crucial to the laparoscopic surgeon. Reducing the technical d ifficulty of laparoscopic procedures is beneficial on many fronts: training is facilitated, operative time is reduced, and the practice of minimally i nvasive surgery can be further disseminated. Many advances in urologic lapa roscopic surgery are attributable to the development of new operative instr uments that reduce the technical difficulty. In this article, we highlight three technical advances in laparoscopy. Hand assistance can simplify many laparoscopic procedures. Because the surgeon retains tactile sensation, ope rative times are reduced compared with standard laparoscopic surgery, with minimal, if any, increase in patient morbidity, Other advances in instrumen tation include various laparoscopic retractors and the Pneumodissector, a u nique dissecting device. The breadth of retractors extends from reusable me tal "fans" to disposable inflated "paddles," with many in between, The meta l retractors may be more traumatic to delicate tissues than the inflatable ones but also are more versatile. The Pneumodissector facilitates tissue di ssection by releasing short burst of carbon dioxide. It is a safe and effec tive instrument for blunt tissue dissection, These technical advances have contributed to the progression of laparoscopic urologic procedures. Technol ogy will continue to have a significant impact on the advancement of laparo scopic urology and its potential widespread dissemination.