Hand Assisted Laparoscopic Surgery: An Updated Descriptive Overview

Introduction: Hand assisted laparoscopic surgery is an updated highly advanced version of
laparoscopic technique. Such technique bridges the gap between traditional surgery and total
laparoscopic surgery. Introduction of the hand intracorporeally enhanced the degree of freedom,
hence, a remarkable degree of precision and safety in task performance.
Clinical and experimental studies confirmed safe use of the hand with insufflation pressure enhancing
dexterity as well as a steep learning curve. Therefore, the author made an overview analysis to the
factors related to safety; efficiency; dexterity; instrumentation and cost-effectiveness for the use of
hand assisted laparoscopic surgery; with an emphasis on live donor nephrectomy.
Results and Discussion: Prospective studies made by Kolvenbach on the use of hand assisted
laparoscopic surgery in aortic aneurysm repair proved high degree of safety and efficiency as well as
cost effectiveness. Several studies highlighted a multitude of factors significantly contributing into a
high degree of precision and task performance; which reflected on uneventful enhanced recovery
programme.
The introduction of either hand intracorporeally enhanced the limited degree of freedom for the current
laparoscopic tools. There are various hand port devices of which the pros and cons for each port will
be discussed in detail. The author’s experimental studies confirmed that optimum safe insufflation
pressure would be 10 mm Hg with no leak from the hand port and optimum dexterity and task
performance.
Conclusion: Hand assisted laparoscopic surgery is a safe and efficient technique. It significantly
enhances concept of Enhanced Recovery programme. Raising public awareness can provide a high
impact in enhancing live donor nephrectomy; hence reducing the inexorable renal transplant waiting
list for patients with end stage renal disease. Such patients are at progressive rise of mortality risk
with prolonged waiting list.