Laparoscopic-assisted Aortic Surgery

Since the initial success and widespread acceptance of laparoscopic cholecystectomy (1), the application of this laparoscopic technique to vascular surgery has been somewhat limited. However, after laparoscopic techniques were first applied to vascular surgery in 1993 (2), many technological developments for this procedure have been accepted. Laparoscopy confers three major benefits: better visualization of the aorta, less bowel manipulation, and avoidance of hypothermia. However, advanced total laparoscopic surgery can be difficult and time-consuming, and its benefits are not yet readily apparent. Laparoscopic-assisted aortic surgery enables the surgeon to use a smaller incision and this reduces surgical trauma when compared with the conventional surgical techniques (3). The use of the HandPort device enables the surgeon to use their hands while maintaining the pneumoperitoneum; this allows the vascular surgeon to maintain the sense of touch, and to perform the aortoprosthetic anastomosis safely with use of a MultiTool instrument. Our two case reports illustrate the feasibility of laparoscopic-assisted aortic surgery via minilaparotomy.

Hand-Assisted Laparoscopic Surgery (HALS) with the HandPort System

PURPOSE: The purpose of this study was to evaluate the feasibility and potential benefits of Hand-Assisted Laparoscopic Surgery (HALS) with the HandPort system. The surgeon inserts the nondominant hand into the abdomen while the pneumoperitoneum is maintained. The hand assists laparoscopic instruments and is helpful in complex laparoscopic surgery. This approach provides an excellent means to explore, to retract safely, and to apply immediate hemostasis when needed. METHODS: A prospective study was performed in patients who had undergone surgical intervention with the HandPort system at Ewha Womans University Mok-Dong Hospital. The surgeon was free to test the device in any situation where they expected a potential advantage over conventional laparoscopy. The surgeon inserted the nondominant hand into the abdomen while the pneumoperitoneum was generally maintained at 13 mmHg. RESULTS: Thirteen patients were entered in the study. Operations included radical gastrectomy in 8 cases, subtotal gastrectomy in 1 case, hemicolecotmy in 2, distal pancreatectomy with splenectomy in 1, nephrectomy with splenectomy in 1. The mean incision size for the HandPort device was 7.5 cm for the nondominant hand. None of the patients required conversion to open surgery as a result of an unmanageable air leak. There were no postoperative problems and no cases of mortality. CONCLUSION: HALS with the HandPort system is helpful in complex laparoscopic surgery and appeared to be useful in minimally invasive procedures considered too complex for,a laparoscopic approach.

A comparative study of hand-assisted laparoscopic versus open hepatectomy for liver cancer / 中国普通外科杂志

Objective To study the feasibility and invasiveness of hand-assisted laparoscopic hepatectomy(HALH) for liver cancer.Methods Forty patients undergoing hepatectomy for liver cancer were randomly divided into HALH group and open hepatectomy(OH) group.Data of patients of two groups,Which included operating time,intraoperative blood loss,length of incision,postoperative flatus time,hospital stay,complications and C-reactive protein(CRP) were compared.Results The mean intraoperative blood loss,length of incision,postoperative flatus time,hospital stay and CRP in HALH group were significantly less than that in OH group;but there was no significant difference in operating time,or complication and recurrence rate.Conclusions HALH for liver cancer is less traumatic,and achieves faster patient recovery.It is feasible and safe in selected patients.