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Invited Critique
May 1999

Invited Critique: Handoscopic Surgery

Arch Surg. 1999;134(5):486. doi:10.1001/archsurg.134.5.486

The Southern Surgical Club has recruited many patients to assess the clinical utility of hand-assisted laparoscopic surgery. This device permits the surgeon to recover the tactile feeling, maintaining the advantages of laparoscopy. The cases chosen include a variety of procedures performed and levels of complexity, which complicate analysis, as reflected by the high conversion rate (22%). Some indications are difficult to accept (eg, hiatal hernia) when results with the standard laparoscopic approach are satisfactory. The best message comes from the analysis of 2 accepted indications: colectomy and splenectomy. The results after colectomy are promising, especially when they include more difficult situations (eg, diverticulitis and intestinal fistula). The authors do not state the characteristics of spleens approached with the hand port, but 4 of 7 were benign, and they could be morcellated. The accessory incision in splenic surgery should be considered only for cases of massive spleen or for retrieval of the intact organ, and it is in this selected group of patients that use of the hand port may be beneficial. Probably the most important data of this work is the surgeon's subjective feeling that this device facilitated the procedure in 88% of cases, with a score higher than 4 on a scale from 0 to 5.

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