Chien-Hui Ou1, Wen-Horng Yang. 1. Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Abstract
PURPOSE: To carry out hand-assisted retroperitoneoscopic nephroureterectomy (HARN) and open bladder cuff excision using a homemade hand-assist device. PATIENTS AND METHODS: Twenty-four consecutive patients with upper tract transitional cell carcinoma received HARN and open bladder cuff excisions. The procedures were carried out using a homemade hand-assist device comprising a medium-sized Alexis wound retractor and surgical gloves. The Alexis wound retractor was positioned through a 7-8-cm Gibson incision ready for use. The surgeon inserted the double-gloved, nondominant hand into the retroperitoneal space via the wound retractor. During the procedure, the cuff of the surgeon's outer surgical glove was turned outside-in and snapped onto the external ring of the Alexis wound retractor to prevent carbon dioxide gas leakage. We successfully created pneumoretroperitoneum by insufflating with carbon dioxide at 15 mm Hg. The procedure was carried out through the 7-8-cm Gibson incision and two additional laparoscopic ports. RESULTS: All procedures were performed without complication. The mean estimated blood loss was 81 mL. The mean operation time was 103 minutes. Morphine (mean, 17.6 mg) was administered for pain relief for 1-3 days following surgery. The mean time for recommencing oral intake was 1.5 days, and that to ambulation was 2.0 days. There were no wound complications related to the homemade hand-assist device. CONCLUSIONS: Preliminary results show that carrying out HARN using a homemade hand-assist device is safe and feasible. Our homemade hand-assist device offers a cost reduction for the HARN procedure over using commercially available devices.
PURPOSE: To carry out hand-assisted retroperitoneoscopic nephroureterectomy (HARN) and open bladder cuff excision using a homemade hand-assist device. PATIENTS AND METHODS: Twenty-four consecutive patients with upper tract transitional cell carcinoma received HARN and open bladder cuff excisions. The procedures were carried out using a homemade hand-assist device comprising a medium-sized Alexis wound retractor and surgical gloves. The Alexis wound retractor was positioned through a 7-8-cm Gibson incision ready for use. The surgeon inserted the double-gloved, nondominant hand into the retroperitoneal space via the wound retractor. During the procedure, the cuff of the surgeon's outer surgical glove was turned outside-in and snapped onto the external ring of the Alexis wound retractor to prevent carbon dioxide gas leakage. We successfully created pneumoretroperitoneum by insufflating with carbon dioxide at 15 mm Hg. The procedure was carried out through the 7-8-cm Gibson incision and two additional laparoscopic ports. RESULTS: All procedures were performed without complication. The mean estimated blood loss was 81 mL. The mean operation time was 103 minutes. Morphine (mean, 17.6 mg) was administered for pain relief for 1-3 days following surgery. The mean time for recommencing oral intake was 1.5 days, and that to ambulation was 2.0 days. There were no wound complications related to the homemade hand-assist device. CONCLUSIONS: Preliminary results show that carrying out HARN using a homemade hand-assist device is safe and feasible. Our homemade hand-assist device offers a cost reduction for the HARN procedure over using commercially available devices.