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Hand-assisted laparoscopic lymphadenectomy: a novel approach to a difficult area
Andrew Sutherland1, Gavin Wright
1Cardiothoracic Surgical Unit, University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia. a_d_sutherland@hotmail.com
Background:
Hand-assisted laparoscopic surgery (HALS) is an emerging technique that is gaining acceptance for a wide range of abdominal procedures. We drew upon our growing experience with hand-assisted laparoscopic and thoracoscopic surgery to manage a case that was felt to require a major thoracoabdominal incision if it were to be completed by conventional open surgery.
Methods:
A technique is described that combines the advantages of both laparoscopic and open surgery in the form of hand-assisted laparoscopic surgery to permit safe dissection of a retrocrural mass extending into the chest.
Results:
We used this technique successfully to completely resect a nodal deposit of metastatic embryonal carcinoma previously thought to be inaccessible to surgical resection.
Conclusion:
The use of hand-assisted laparoscopic surgery improves tactile and visual feedback for the operator. This allows complex procedures involving delicate dissection to be completed safely and with less morbidity than open surgery.
