Influence of compression pressure from the hand access device on hand microcirculation during hand-assisted laparoscopic surgery.
BACKGROUND
Hand access devices in hand-assisted laparoscopic surgery depend on compression pressure to prevent air leakage. Surgeons frequently experience hand ache during surgery. This study aimed to test whether the pressure with such a device affects the microvascular function of the hand.


METHODS
Eight healthy volunteers participated in this experimental study. The hand access device, applied to the forearm, was inflated to 0, 8, 12, and 16 mmHg in a random order, and the microvascular activity of the skin of the hand dorsum was quantified using laser Doppler and iontophoresis of increasing doses of acetylcholine (endothelial-dependent vasodilator) and sodium nitroprusside (endothelial-independent vasodilator). The end point was skin erythrocyte flux ratio as a measure of microvascular skin activity.


RESULTS
No significant differences in microvascular responses to iontophoresis of acetylcholine and sodium nitroprusside were found at the four doses used when the hand access device was inflated at different pressures. The peak values for the hand allocated to acetylcholine were 3.48 +/- 1.33, 3.42 +/- 2.33, 3.38 +/- 2.55, and 2.84 +/- 3.10 arbitrary units, and the peak values for the hand allocated to sodium nitroprusside were 2.79 +/- 1.60, 2.00 +/- 1.60, 2.30 +/- 1.50, and 2.40 +/- 1.62 arbitrary units at cuff pressures of 0, 8, 12, and 16 mmHg, respectively.


CONCLUSIONS
The pressure in the hand access device up to 16 mmHg does not affect the hand cutaneous microcirculation.
Manasnayakorn
S
S
Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London, UK. msopark@gmail.com
Khan
F
F
Levison
R A
RA
Cuschieri
A
A
Hanna
G B
GB
D000328:Adult; D005260:Female; D006225:Hand / Q000098:blood supply*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008833:Microcirculation; D010146:Pain / Q000209:etiology*; D011312:Pressure; D013525:Surgical Instruments / Q000009:adverse effects*; D055815:Young Adult