Technical advances in laparoscopy: hand assistance, retractors, and the pneumodissector

Technology is crucial to the laparoscopic surgeon. Reducing the technical difficulty of laparoscopic procedures is beneficial on many fronts: training is facilitated, operative time is reduced, and the practice of minimally invasive surgery can be further disseminated. Many advances in urologic laparoscopic surgery are attributable to the development of new operative instruments that reduce the technical difficulty. In this article, we highlight three technical advances in laparoscopy. Hand assistance can simplify many laparoscopic procedures. Because the surgeon retains tactile sensation, operative times are reduced compared with standard laparoscopic surgery, with minimal, if any, increase in patient morbidity. Other advances in instrumentation include various laparoscopic retractors and the Pneumodissector, a unique dissecting device. The breadth of retractors extends from reusable metal "fans" to disposable inflated "paddles," with many in between. The metal retractors may be more traumatic to delicate tissues than the inflatable ones but also are more versatile. The Pneumodissector facilitates tissue dissection by releasing short burst of carbon dioxide. It is a safe and effective instrument for blunt tissue dissection. These technical advances have contributed to the progression of laparoscopic urologic procedures. Technology will continue to have a significant impact on the advancement of laparoscopic urology and its potential widespread dissemination.