Hand-assisted laparoscopy for multiple organ removal

Simultaneous removal of multiple organs is a situation seldom encountered by the urologist but may be needed in patients with adult polycystic kidney disease or malignancies or infectious processes involving more than one organ. Historically, open surgery has been considered necessary to gain adequate exposure. However, hand-assisted laparoscopic surgery is suitable for many of these patients. The hand-port and trocar positions are chosen according to the laparoscopic experience of the surgeon and depend on whether an ambidextrous or nondominant-hand procedure is planned. Several techniques are described, with a focus on bilateral nephrectomy.