|
Choosing
a site for placement assist devices such as the HandPort
should wait until the abdomen has been insufflated. The
distortion of the abdominal wall under pneumoperitoneum would
change the ultimate position and length of any incision
attempted prior to insufflating. A site is then chosen.
Optimal position of the hand is one that allows for
triangulation with the other laparoscopic instruments and
therefore substitutes for a typical port site in standard
laparoscopy. The length of incision correlates mainly with
breadth of the palm. This length also approximates the size of
the surgeon’s glove (for most 7-8 cm). The incision is then
carried full thickness. Loss of pneumoperitoneum will occur at
this stage.
|
The HandPort System
consists of three separate parts: the base
retractor, bracelet, and sleeve. The
following describes in brief the set up necessary for
this hand-assist device. First, the inner ring of the base
retractor is placed within the abdominal cavity
through the incision created. The outer ring is then
inflated and the HandPort Retractor Base is
atraumatically sealed to the peritoneum.
|
|
 |
Next,
the hand is then prepared to receive and
enter the base retractor. The bracelet
should have already been placed under
sterile conditions to the wrist of the
surgical gown if ultimately only one pair of
gloves is planned. If the surgeon prefers to
double glove then the bracelet may be
placed in a sterile manner on the wrist
between the two pair of gloves. We have
found that wearing brown gloves as the sole
or exterior glove reduces glare. The sleeve
is then placed over the forearm and its
tapered end easily secures to the bracelet. |
|
|
The hand is then
introduced through the base retractor and the wider
end of the sleeve is secured to the base retractor and
the abdomen re-insufflated.
(Note: Conceptually, a right- handed surgeon
may prefer to introduce his/her non-dominant hand
through a mirror image set up while operating from the
patient’s left side. Either should allow good
exposure and functional assistance. Either would have
the potential for conversion if necessary.)
|
 |
|
|
With
the hand introduced, a combination of visual and
tactile exploration may be carried out. Laparoscopic
ultrasound is a useful adjunct to the initial
exploration in cases of suspected malignancy |
|
