title: Hand-assisted laparoscopic surgery (HALS) with the HandPort system: initial experience with 68 patients.
abstract: OBJECTIVE
  To evaluate the feasibility and potential benefits of hand-assisted laparoscopic surgery with the HandPort System, a new device.
  
  
  BACKGROUND
  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 10 laparoscopic surgical centers. Surgeons were free to test the device in any situation where they expected a potential advantage over conventional laparoscopy.
  
  
  RESULTS
  Sixty-eight patients were entered in the study. Operations included colorectal procedures (sigmoidectomy, right colectomy, resection rectopexy), splenectomy 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 to insert their nondominant hand into the abdomen. Pneumoperitoneum was generally maintained at 14 mmHg, and only one patient required conversion to open surgery as a result of an unmanageable air leak. Hand fatigue during surgery was noted in 20.6%.
  
  
  CONCLUSIONS
  The hand-assisted technique appeared to be useful in minimally invasive colorectal surgery, splenectomy for splenomegaly, living-related donor nephrectomy, and procedures considered too complex for a laparoscopic approach. This approach provides excellent means to explore, to retract safely, and to apply immediate hemostasis when needed. Although the data presented here reflect the authors' initial experience, they compare favorably with series of similar procedures performed purely laparoscopically.
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Litwin
authors.forename: A
authors.initials: A
authors.lastname: Darzi
authors.forename: J
authors.initials: J
authors.lastname: Jakimowicz
authors.forename: J J
authors.initials: JJ
authors.lastname: Kelly
authors.forename: D
authors.initials: D
authors.lastname: Arvidsson
authors.forename: P
authors.initials: P
authors.lastname: Hansen
authors.forename: M P
authors.initials: MP
authors.lastname: Callery
authors.forename: R
authors.initials: R
authors.lastname: Denis
authors.forename: D L
authors.initials: DL
authors.lastname: Fowler
authors.forename: D S
authors.initials: DS
authors.lastname: Medich
authors.forename: M J
authors.initials: MJ
authors.lastname: O'Reilly
authors.forename: H
authors.initials: H
authors.lastname: Atlas
authors.forename: J M
authors.initials: JM
authors.lastname: Himpens
authors.forename: L L
authors.initials: LL
authors.lastname: Swanstrom
authors.forename: E J
authors.initials: EJ
authors.lastname: Arous
authors.forename: P
authors.initials: P
authors.lastname: Pattyn
authors.forename: S M
authors.initials: SM
authors.lastname: Yood
authors.forename: R
authors.initials: R
authors.lastname: Ricciardi
authors.forename: A
authors.initials: A
authors.lastname: Sandor
authors.forename: W C
authors.initials: WC
authors.lastname: Meyers
mesh_terms: D000005:Abdomen / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013525:Surgical Instruments