Unique Factors

Patients with prior peritonitis, or abdominal surgery with postoperative complications that would be expected to worsen abdominal scarring, are the only subgroups in which we distinctly avoid a transperitoneal laparoscopic approach. Interestingly, patients with smaller abdomens, or prior abdominoplasty procedures, tend to be more challenging for hand assistance, because there is less room to work once the surgeon's hand is in the abdomen. These patients may benefit more from standard laparoscopy.

When selecting patients for hand-assisted laparoscopy, several factors play a role. While prior abdominal surgery poses an increased risk in standard laparoscopy, we have found making the hand incision first, gaining safe abdominal access, and then inspecting the insufflated abdomen with the laparoscope and placing ports under endoscopic control to be quite efficient.

In contrast, morbidly obese patients do very well with hand-assisted laparoscopy, as their abdomens are usually capacious, and the significance of the hand incision is much less over an over significant surface area. Finally, cosmesis plays a role in the decision-making. While standard laparoscopy avoids any incision, often more trocar sites are utilized. The hand incision in many patients can be Pfannesteil, and thus cosmeti-cally preferable as there are fewer port sites. However, generally we utilize a midline or lower abdominal location, and thus create an abdominal scar.

In general, the overriding benefit of hand-assisted laparoscopy is the surgeon's confidence in the approach. Many times, a surgeon may opt for a hand-assisted laparoscopy procedure over a standard laparoscopic approach, and visa versa based on technical preference.

Hand-assisted laparoscopy allows shortened operating time, reduced need for conversion, enhanced teaching capability, and ease of control of hemorrhage, all if which benefit the busy clinician.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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