The metabolic response to laparoscopic and open nephrectomy

Hand-assisted laparoscopic surgery: an overview

BACKGROUND

Advanced laparoscopic surgery is complex and time-consuming. Achieving consistent efficacy and safety throughout the entire procedure is always a problem. For this reason, hand-assisted laparoscopic surgery (HALS) was developed.

METHODS

Devices were designed to allow manual access to the abdomen through the utility laparotomy. By using one hand in the abdomen during laparoscopy, the surgeon regains direct tactile sensation and acquires improved hand-eye coordination. The safety of the individual devices has been tested in RCT for the registration of the individual devices. An index known as Surgical Action Efficiency was calculated for in six patients undergoing laparoscopic colon resection and six patients with hand-assisted colon resections.

RESULTS

All of the registered devices are safe. Surgical Action Efficiency for the laparoscopy group was 55 +/- 14%; for the HALS group, it was 71 +/- 4%. This result is statistically significant (p < 0.05).

CONCLUSION

HALS is a safe and efficient method by which it is possible to combine the established convenience and safety of open surgery with the advantages of minimally invasive surgery.

Comparison of efficiencies of three techniques for colon surgery

PURPOSE

To determine the most efficient technique for performing a colectomy, we used the methodology of time-motion analysis.

METHODS

The efficiency of five hand-assisted and six regular laparoscopic colectomies and one open colectomy, performed by four surgeons in three different hospitals, was measured. The open colectomy was analyzed as a reference procedure.

RESULTS AND CONCLUSIONS

The hand-assisted laparoscopic technique was the most efficient. Hand-assisted laparoscopy was therefore less time consuming than laparoscopic surgery. Open surgery was the fastest technique, because the time for every surgical motion is a factor of three shorter than for the two laparoscopic techniques.

Splenectomy revised: manually assisted splenectomy with the dexterity device--a feasibility study in 22 patients

Laparoscopic splenectomy claims a number of advantages over open surgery: less trauma, quicker recovery, and faster return to normal activity. On the other hand, laparoscopic splenectomy is complex and time consuming, and so far, many surgeons are reluctant to perform such an operation. A new device was designed to give manual access to the abdomen through a utility laparotomy. By using one hand in the abdomen during laparoscopy, the surgeon regains direct tactile sense and hand-eye coordination. A pilot study to assess the feasibility of this method has been performed in 22 patients. The operation could be completed easily in 21 patients (95%). The average blood loss was 230 mL, and the average postoperative stay was 3.9 days. With this simple, inexpensive method, it is possible to combine the established convenience, safety, efficacy of open surgery with the advantages of minimally invasive surgery.

Modified minimal cost retroperitoneoscopic nephrectomy, nephrectomy with isthumusectomy and nephroureterectomy in children: a pilot study

OBJECTIVE

To assess the feasibility of retroperitoneoscopic nephrectomy, nephrectomy with isthmusectomy and nephroureterectomy in children with nonfunctioning kidneys and renal anomalies, at minimal cost using a modified technique.

PATIENTS AND METHODS

Eleven children (aged 4-16 years) underwent retroperitoneoscopic nephrectomy, nephroureterectomy, or nephrectomy with isthmusectomy for nonfunctioning kidneys. Three patients had previously undergone percutaneous nephrostomy to evaluate whether the kidney could be salvaged, but this did not alter the success of technique, although adhesions and fibrosis required careful and precise dissection.

RESULTS

All procedures were completed successfully with minor complications (peritoneal transgression via the port in two patients, with no consequences). The mean operative duration, blood loss and hospital stay were 109 min, 82 mL and 2.25 days, respectively.

CONCLUSION

Retroperitoneoscopic procedures can be conducted safely, successfully and at minimal cost without compromising any principles of technique. It is not essential to prepare the bowel or use ureteric catheterization and renal artery embolization. Expensive balloon dissectors, trocar-sealing balloons, endostaplers and endobags, lap sacs or morcellators are not required. The direct approach to the kidney via retroperitoneoscopy is also quicker.