title: Retroperitoneoscopic hand-assisted nephroureterectomy using a homemade device.
abstract: OBJECTIVE
  To carry out hand-assisted retroperitoneoscopic nephroureterectomy (HARN) and open bladder cuff excision using a homemade hand-assist device.
  
  
  METHODS
  Twenty-four consecutive patients with upper tract transitional cell carcinoma received HARN and open bladder cuff excisions. The procedures were carried out using a homemade hand-assist device comprising a medium-sized Alexis wound retractor and surgical gloves. The Alexis wound retractor was positioned through a 7-8-cm Gibson incision ready for use. The surgeon inserted the double-gloved, nondominant hand into the retroperitoneal space via the wound retractor. During the procedure, the cuff of the surgeon's outer surgical glove was turned outside-in and snapped onto the external ring of the Alexis wound retractor to prevent carbon dioxide gas leakage. We successfully created pneumoretroperitoneum by insufflating with carbon dioxide at 15 mm Hg. The procedure was carried out through the 7-8-cm Gibson incision and two additional laparoscopic ports.
  
  
  RESULTS
  All procedures were performed without complication. The mean estimated blood loss was 81 mL. The mean operation time was 103 minutes. Morphine (mean, 17.6 mg) was administered for pain relief for 1-3 days following surgery. The mean time for recommencing oral intake was 1.5 days, and that to ambulation was 2.0 days. There were no wound complications related to the homemade hand-assist device.
  
  
  CONCLUSIONS
  Preliminary results show that carrying out HARN using a homemade hand-assist device is safe and feasible. Our homemade hand-assist device offers a cost reduction for the HARN procedure over using commercially available devices.
authors.affiliation: Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Chien-Hui
authors.initials: CH
authors.lastname: Ou
authors.forename: Wen-Horng
authors.initials: WH
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000295:instrumentation*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery*