The advantages of hand-assisted laparoscopy

Abstract

The technical challenges of performing laparoscopic renal surgery require fellowship training and are associated with a steep learning curve. For the established urologist in practice, fellowship training is not a reality. As a result of these obstacles, in the late 1990s, laparoscopic renal surgery was entering the domain of the general surgeons who had a large number of laparoscopic procedures at their disposal to develop laparoscopic skills. Hand-assisted laparoscopic renal surgery is a hybrid procedure combining the most salient features of open renal surgery and laparoscopic renal surgery. By allowing the surgeons to place their non-dominant hand into the abdominal cavity, palpation and spatial orientation became possible, lessening the learning curve for laparoscopic surgery. Moreover, hand-assisted laparoscopic surgery could be applied to a variety of renal surgeries, extirpative and reconstructive, with results similar to those already achieved by standard laparoscopy. Throughout the past 5 years, hand-assisted laparoscopy has allowed urologists to incorporate laparoscopic renal surgery into their practices to the benefit of their patients and of their specialty. This review article offers a historical review of the development of hand-assisted laparoscopy and describes the procedures commonly performed today using this technique.

Incorporation of Hand-Assisted Laparoscopic Nephrectomy into an Academic Training Program: An Assessment of the Utility of a 3-Month Minifellowship

“…Chief resident B performed 3 cases as operative surgeon. Two (2) fourth-year (PGY4) residents performed 2 cases each as operative surgeon. Of the 14 HALNs completed in cohort 2, chief resident A assisted on 2 cases and was the operative surgeon on 6 of his next 7 procedures.…”

“…1 The technical challenges of performing standard laparoscopic renal surgery are significant, with the learning curve estimated by some to be approximately 30-40 cases, and HAL has been recommended as an effective technique to more rapidly incorporate minimally invasive renal surgery into a surgeon's practice. [2][3][4] Prior studies have estimated that performing 10 hand-assisted retroperitoneoscopic nephrectomy procedures may be reasonable preparation for the "less experienced" urolo-436 BROWN ET AL. gist to begin standard laparoscopic procedures, and that the operative times of standard laparoscopic nephrectomy approached open nephrectomy after approximately 10 cases.…”

Learning curve in human laparoscopic surgery

“…Hand-assisted renal laparoscopy can act as a bridge in such situations. Hand-assisted laparoscopic renal surgery is a hybrid procedure combining the most salient features of open renal surgery and laparoscopic renal surgery [24]. The loss of the tactile sensation is certainly a major factor that prolongs the learning curve with laparoscopic surgery.…”

Laparoscopy Training Courses in Urology

“…(Gaston KE et al, 2004) The hand-assisted approach also allowed older urologists that had not been trained in laparoscopy to begin to perform laparoscopic cases and helped bridge the gap from open surgery and a pure laparoscopic approach. (Munver R et al, 2004) With the rapid advances in technology in the field of urology, post-graduate training courses are important to help bridge the technology gap for current practicing urologists. The development of newer high-fidelity simulators and metrics for assessing laparoscopic skill acquisition are essential in order for us to better teach laparoscopic surgery.…”