Hand-assisted technique beneficial for challenging laparoscopies

A technique that bridges minimally invasive surgery and an open approach appears to have promise for challenging cases in laparoscopic myomectomy and hysterectomy, according to preliminary outcomes from a surgical series by investigators at Brigham and Women’s Hospital, Boston.

To test the feasibility of a hand-assisted technique, Jon I. Einarsson, MD, MPH, and colleagues used the protocol to perform myomectomy or hysterectomy on 15 patients between March 2009 and April 2012. Dr. Einarsson is the deputy editor of Contemporary OB/GYN.

The retrospective case report, published in The Journal of Minimally Invasive Gynecology, represents the largest such surgical series and included 5 hand-assisted laparoscopic myomectomies, 8 supracervical hysterectomies, and 2 total laparoscopic hysterectomies.

Median duration of surgery was 19 minutes (range: 86 to 269 minutes) and median estimated blood loss was 250 mL (range: 30 to 4000 mL). The 3 cases of intraoperative complications were extreme blood loss in excess of 1000 mL. Symptomatic uterine leiomyomata (median weight 1780 g; range 1006 to 2012 g) were the primary indication for the procedures.

The hand-assisted technique involved using the GelPort Laparoscopic system to gain rapid hand access inside the abdomen in an air-sealed environment. The technique is easy, the authors said, and allows for quick hand access at any point during a surgical procedure. The major benefits they noted were the ability to mobilize a large fibroid uterus that was significantly obstructing the surgical field and the ability to spend less time extracting specimens with a laparotomy incision.

More studies are needed on the technique, but the investigators concluded that the approach holds potential for experienced laparoscopic surgeons who want more control of the operative site and better postoperative outcomes for patients.