Hand-Assisted Laparoscopic Surgery (HALS) With the HandPort System

TLDR

Hand‑assisted laparoscopic surgery (HALS) involves inserting a surgeon’s hand into the abdomen while maintaining pneumoperitoneum, and the HandPort System is a new device designed to facilitate this approach. The study aimed to assess the feasibility and potential benefits of HALS using the HandPort System. A prospective, nonrandomized, multi‑center study enrolled 68 patients across 10 centers, allowing surgeons to use the HandPort in a variety of procedures where they anticipated an advantage over conventional laparoscopy. Results showed a mean incision of 7.4 cm, 78 % of surgeons preferred the nondominant hand, pneumoperitoneum was maintained at 14 mmHg with only one conversion, hand fatigue occurred in 20.6 %, and the technique proved useful and comparable to purely laparoscopic series.

Abstract

To evaluate the feasibility and potential benefits of hand-assisted laparoscopic surgery with the HandPort System, a new device.In hand-assisted laparoscopic surgery, the surgeon inserts a hand into the abdomen while pneumoperitoneum is maintained. The hand assists laparoscopic instruments and is helpful in complex laparoscopic cases.A prospective nonrandomized study was initiated with the participation of 10 laparoscopic surgical centers. Surgeons were free to test the device in any situation where they expected a potential advantage over conventional laparoscopy.Sixty-eight patients were entered in the study. Operations included colorectal procedures (sigmoidectomy, right colectomy, resection rectopexy), splenectomy for splenomegaly, living-related donor nephrectomy, gastric banding for morbid obesity, partial gastrectomy, and various other procedures. Mean incision size for the HandPort was 7.4 cm. Most surgeons (78%) preferred to insert their nondominant hand into the abdomen. Pneumoperitoneum was generally maintained at 14 mmHg, and only one patient required conversion to open surgery as a result of an unmanageable air leak. Hand fatigue during surgery was noted in 20.6%.The hand-assisted technique appeared to be useful in minimally invasive colorectal surgery, splenectomy for splenomegaly, living-related donor nephrectomy, and procedures considered too complex for a laparoscopic approach. This approach provides excellent means to explore, to retract safely, and to apply immediate hemostasis when needed. Although the data presented here reflect the authors' initial experience, they compare favorably with series of similar procedures performed purely laparoscopically.