A Novel Technique for Hand-Assisted Laparoscopy in Difficult Nephrectomies-Is One Hand Better Than Two? A Single-Centre, Single-Surgeon Series

Abstract

Laparoscopic radical nephrectomy is the standard of care for T1 renal tumors and nowadays being used for T2 or higher tumors, resulting in higher the conversion rates. To bridge this gap, the hand-assisted laparoscopy (HAL) method was introduced. Even now, in the robotic era, this HAL approach continues to find importance in urology, especially in the most challenging cases, albeit, with a relatively low usage rate due to the cost involved and availability of hand port devices. Here, we report a case series using a novel modification of the HAL nephrectomy (HALN) technique when open conversion is needed. From a prospective database, we retrospectively analyzed the data of Six patients who underwent HALN at the All India Institute of Medical Sciences between January 2019 and December 2022. Indications for surgery included both malignant and benign renal disease. Four surgeries were performed on the right side while two were performed on the left. Five patients underwent a HALN for renal cell carcinoma (RCC) and 1 for a benign non-functioning kidney. In our series, all the cases with RCC had were T2a or higher. Our case series shows that HALN is technically safe, effective, and a great adjunct to conventional laparoscopy. The ingenious use of a surgical glove as a hand port is an easy-to-make-and- use device in such challenging surgeries.

Keywords: Hand-assisted laparoscopy; Laparoscopic nephrectomy; Novel technique; RCC; Surgical innovation.

Fig. 1

The novel glove-port technique. a Glove being removed (Arrow), which will be used as the hand-port. b Our novel glove-port technique. The larger glove being removed from the surgeon’s hand, for use as the glove-port. c Allies forceps being used to fix the glove to the skin edges

Fig. 2

Intraoperative images showing the Surgeons fingers being used for dissection. a Fingers being used for milking the thrombus into the renal vein. b The tumour thrombus clearly visualized in the renal vein after manipulation by the surgeon’s fingers. c The surgeon’s fingers being used for posterior dissection of the kidney

Fig. 3

Pre-operative imaging of the patients. a Computed tomography showing a large vesical calculus. b CECT showing a large left renal mass, with large para-aortic lymph nodes