Hand-assisted laparoscopic nephrectomy in the pig: Initial report

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Abstract
We describe the conversion from an open surgical nephrectomy to a manually assisted laparoscopic procedure in the porcine model. A newly devised sleeve allows the surgeon's hand to be used in the abdomen while maintaining a leakage-free pneumoperitoneum. Using one hand for retraction, grasping, blunt dissection and direct tactility whilst using conventional laparoscopic instruments with the other hand, under the guidance of the laparoscope, facilitates a difficult laparoscopic procedure. We performed six manually assisted transperitoneal laparoscopic nephrectomies in pigs with the pneumo-sleeve and compared them with two entirely laparoscopic nephrectomies. The manually assisted procedures took 30-45 min, compared to 90-120 min for the entirely laparoscopic nephrectomies. No complications were seen in either group. We found the manually assisted laparoscopic nephrectomy quick and easy to perform, it has the advantages of both the open and the laparoscopic approach without the disadvantages of these procedures.