Laparoscopic hand-assisted hepatic surgery.

At Ninewells Hospital, we have changed from total to hand-assisted laparoscopic hepatic resections. We report here our initial experience on 10 anatomic hepatic resections with good outcome, and 1 with a significant postoperative complication (fall in the hemoglobin) requiring laparotomy. All resections were undertaken by using the Omniport device (Advanced Surgical Concepts, Dublin, Ireland). The hand-assisted laparoscopic surgery (HALS)-Omniport approach has also been used selectively in 5 patients undergoing in situ ablation for bilateral metastatic disease with lesions not easily accessible to the total laparoscopic approach, ie, situated in the posterior and inferior segments of the right liver. The HALS approach has several advantages; it facilitates and expedites the procedure, reduces the stress factor to the surgeon, greatly improves exposure, and provides an immediate and efficient control of bleeding vessels with the internal hand. The Omniport device, which essentially consists of a handcuff with a spiral inflatable valve, enables withdraw and reinsertion of the hand without loss of pneumoperitoneum during the procedure. The device was effective in maintaining pneumoperitoneum in all cases. All operations were completed with the HALS approach.