title: Hand-assisted laparoscopic approach to multiple-organ removal.
abstract: BACKGROUND
  Over the past decade, laparoscopy has matured to a common, and in some cases, standard surgical approach. Over this time period, many technological advances have contributed to this progression, one of which is hand assistance. Hand-assisted laparoscopy allows a shortened technical learning curve, security and ease in dissection, the ability to remove organs en bloc, and shorter operative times while maintaining the postoperative advantages of laparoscopy.
  
  
  METHODS
  We present our experience with a hand-assisted laparoscopic approach for two patients requiring bilateral nephrectomy in preparation for renal transplantation and a third patient having concurrent right simple nephrectomy and simple cystectomy for chronic pyocystis.
  
  
  RESULTS
  The hand-assisted approach allowed for utilization of one anesthetic, repositioning of the patient without violating the sterile field, and a short convalescent time. The average hospital stay was 5 days, including two patients who required postoperative revascularization of their clotted arteriovenous fistulas.
  
  
  CONCLUSIONS
  The established indications for hand-assisted laparoscopy include removal of large surgical specimens en bloc, anticipated difficult dissection, and failure of standard laparoscopic procedure progression. We propose that removal of multiple organs should be added to this list.
authors.affiliation: UC Davis Medical Center, Department of Urology, Sacramento, California 95817, USA.
authors.forename: S
authors.initials: S
authors.lastname: Troxel
authors.forename: S
authors.initials: S
authors.lastname: Das
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015653:Cystectomy / Q000379:methods*; D003556:Cystitis / Q000601:surgery; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D013492:Suppuration