[Laparoscopic hand-assisted operation. Review of the literature and initial personal experiences with the HandPort System].
BACKGROUND
During complex laparoscopic operations sometimes the situation of a "missing hand" will occur. Using a device for hand assistance, the surgeon can place one hand into the abdominal cavity to assist the laparoscopic procedures.


METHODS
After a laparotomy of 7-8 cm length, the surgeon can bring one hand into the abdomen via a special device maintaining the pneumoperitoneum. This hand can be helpful, i.e. for exploration, for retraction of gut and organs or for extraction of the specimen. Indications are complex laparoscopic operations such as stomach or colonic resections or splenectomies. In obese patients or patients with extended adhesions, preparation can be facilitated.


RESULTS
The literature review and the author's own results with 10 patients since 2000 show remarkable advantages in operative situations when the laparoscopic procedure is complicated or even impossible. In our 10 patients, all operations could be managed laparoscopically by using the HandPort device.


CONCLUSIONS
Complicated operations can be performed laparoscopically without conversion to conventional laparotomy by using the hand assistance. These patients do not have to forgo to the benefit of minimally invasive operations.
Carus
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Chirurgische Klinik I-Allgemein-, Visceral- und Gefässchirurgie, Städtische Kliniken, Lukaskrankenhaus Neuss GmbH. chirurgie@web.de
Coburg
A J
AJ
D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006498:Hepatectomy / Q000295:instrumentation; D006801:Humans; D020706:Laparoscopes; D010173:Palpation / Q000295:instrumentation*; D011028:Pneumoperitoneum, Artificial / Q000295:instrumentation*; D013156:Splenectomy / Q000295:instrumentation; D013525:Surgical Instruments