TECHNIQUE OF HANDOSCOPIC COLECTOMY

Abstract

Introduction and aim: Ever since the introduction of laparoscopic surgery, the disadvantage of lack of tactile sensation has not been overcome. Over the past months, we had performed 16 handoscopic colectomies, we hereby demonstrate this method which can overcome the above problem by the following video.Method and material: We performed handoscopic right hemicolectomy for a patient suffered from carcinoma of right colon. After being anaesthesized, the patient was put in a modified lithotomy position. Pneumoperitoneum was created by the open method followed by a diagnostic laparoscopy. The air tight hand port system (Smith & Nephew, MA USA) was then inserted in the infraumbilical region with skin incision length equivalent to the width of the surgeon's wrist (6.5 cm in our case). A 12 mm working port was then introduced in the supraumbilical region for the harmonic scalpel. Dissection proceeded in the usual order with the hand retracting, bluntly dissecting and the harmonic scalpel cutting. The bowel was then exteriorized for resection and anastomosis.Results: The surgery completed in 145 minutes with 10 mL blood loss. The patient resumed normal diet on day 4 and was then discharged on day 5. After 12 weeks of follow up, she encountered no adverse outcome.Discussion: The handoscopic technique provides tactile sensation and allows blunt dissection that are not possible for the purely laparoscopic technique. Any bleeding can be effectively controlled by fingers rapidly before definitive haemostatic measures. The enlarged view provides by the laparoscope enhances meticulous dissection for apical lymphadenectomy. Furthermore, the hand port itself is an effective protector of the wound minimizing wound contamination.Conclusion: Handoscopic colectomy is a feasible and promising procedure that enjoys the benefits of both the laparoscopic and open techniques.