Hand-assisted laparoscopic surgery using Gelport

Abstract

Introduction:Minimally invasive surgery has revolutionized general surgery during the past 10 years. However, for more advanced surgical procedures, the acceptance of the minimally invasive approach has been slower than expected. Advanced laparoscopic surgery is complex and time-consuming. The major drawbacks of laparoscopic surgery are two-dimensional view, lack of depth perception and loss of tactile sensation. This has led to the innovation of hand-assisted laparoscopic surgery (HALS). The objective of the present study was to determine that safety of HALS.Materials and Methods:We preformed 18 HALS procedures in our department between July 2003 and January 2005 on patients who had given their informed consent for the use of Gelport. Out of these, 15 were colectomy, 2 nephrectomy and 1 splenectomy. Out of the 18 patients, 13 were males and 5 were females with the age group ranging from 44 to 72 years.Results:Hand-assisted laparoscopic surgery could be completed in 17 patients maintaining all the oncological principals of surgery. The mean operating times were 120 min for right haemicolectomy, 135 min for left colectomy, 150 min for splenectomy, and 150 min for nephrectomy. The patient undergoing radical nephrectomy by HALS had to be converted to open surgery. As the tumour was large and adherent to the spleen and posterior peritoneal wall. Postoperative recovery was excellent with an average hospital stay of 5 days. Histopathology report showed wide clearance and till date we have a good follow up of 30–380 days.Conclusion:Hand-assisted laparoscopic surgery allows tactile sensation and depth perception thereby may simplify the complex procedures. This may result in reduction of operating time and conversion rates at the same time maintaining all the oncological principles. Hand-assisted laparoscopic surgery strikes a perfect balance between an extended open laparotomy incision and an excessively tedious laparoscopic exercise. Hand assistance is an initial tool for the trainee laparoscopic surgeon or a last resort for the experienced laparoscopic surgeon.

Retroperitoneoscopic donor nephrectomy with a gel-sealed hand-assist access device

“…This preperitoneal wound was connected to the mentioned retroperitoneal space. A hand-assist access device, GelPort, (Applied Medical, Rancho Santa Margarita, CA, USA) was put inside the pararectal surgical wound; the GelPort system is an innovative wound sealing device that permits the access of the hand to the surgical field, free trocar site choice and exchange within it, and rapid conversion to open surgery if necessary, while preserving the pneumoperitoneum/pneumoretroperitoneum [12]. …”

Ergonomics in laparoscopic surgery

“…Recently, GelPort laparoscopic systems have been introduced which restore spatial awareness and tactile feet while maintaining pneumoperitoneum. [ 20 ] It is possible to achieve rapid atraumatic manipulation, dissection, palpation and mobilisation of critical vessel by the surgeon's hand. This has been shown to lead to improved procedural times and also has given impetus to the concept of Hand Assisted Laparoscopic Surgery.…”