Hand-assisted laparoscopic lymphadenectomy: a novel approach to a difficult area.
BACKGROUND
Hand-assisted laparoscopic surgery (HALS) is an emerging technique that is gaining acceptance for a wide range of abdominal procedures. We drew upon our growing experience with hand-assisted laparoscopic and thoracoscopic surgery to manage a case that was felt to require a major thoracoabdominal incision if it were to be completed by conventional open surgery.


METHODS
A technique is described that combines the advantages of both laparoscopic and open surgery in the form of hand-assisted laparoscopic surgery to permit safe dissection of a retrocrural mass extending into the chest.


RESULTS
We used this technique successfully to completely resect a nodal deposit of metastatic embryonal carcinoma previously thought to be inaccessible to surgical resection.


CONCLUSIONS
The use of hand-assisted laparoscopic surgery improves tactile and visual feedback for the operator. This allows complex procedures involving delicate dissection to be completed safely and with less morbidity than open surgery.
Sutherland
Andrew
A
Cardiothoracic Surgical Unit, University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia. a_d_sutherland@hotmail.com
Wright
Gavin
G
D000328:Adult; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000556:secondary* / Q000601:surgery*; D009919:Orchiectomy; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery; D014110:Touch