Handassisted Laparoscopy

With the hand-assisted laparoscopic approach, a standard 6 to 8 cm incision is made at the outset of the procedure, and the pneumoperitoneum is commonly obtained via the hand-assisted device. With the hand-assisted laparoscopic approach, access-related bowel and vascular complications should be extremely rare. In contrast, wound complications such as herniation and infection are more common (38). Care should be taken to avoid inclusion of a bowel loop during closure of the hand-assisted device site,

Minor injuries to the liver or spleen may be controlled by compression onto the bleeding site with a rolled surgical gauze, or hemostatic cellulose gauze. Surgical hemostatic agents such as fibrin glue or FlosealĀ® are also very useful for superficial injuries to the liver and spleen. If these measures fail, open surgical repair of a liver injury or splenectomy may be necessary.

Pancreatic injury can occur during left-sided renal or adrenal surgery.

In all cases of suspected pancreatic injury, an intra-abdominal suction drain is left in the left renal bed, and postoperatively, fluid from the drain is sent for amylase levels for evidence of pancreatic injury.

cBaxter, Deerfield, IL.

because these are difficult wounds to close with the patient in a semilateral position. Prospective, randomized trials are in progress to truly compare the relative efficacy and safety of hand-assisted versus standard laparoscopic techniques.

If the bowel function does not return early, causes such as postoperative ileus, bowel perforation, or trocar site hernia causing bowel obstruction should be suspected.

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