PTU - Polskie Towarzystwo Urologiczne
list of articles:

Hand Assisted Laparoscopy in Urology
Article published in Urologia Polska 2002/55/3.


Sławomir Paweł Woźniak, Romuald Zdrojowy, Janusz Dembowski
Katedra i Klinika Urologii Akademii Medycznej we Wrocławiu
Kierownik katedry i kliniki: prof, dr hab. Jerzy Lorenz


laparoscopy, nephrectomy, nephrourcterectomy, adrenalectomy


In order to reduce the technical challenge of urologie laparoscopic surgery, investigators have introduced the concept ot „hand-assisted laparoscopy\".
HAL is a hybrid technique that incorporates features of both standard laparoscopy and open surgery. The surgeon\'s dominant hand controls the laparoscopic instruments used for dissection, suturing, clip application, etc. The surgeon\'s non-dominant hand replaces a laparoscopic instrument: It enters the abdominal cavity through a 7 cm incision to palpate tissues, providing the surgeon with spatial orientation and tactile sensation, as in open surgery. A laparoscope provides the view of the operative field. The presence of the hand allows for tactile sensation, a 3-dimensional spatial orientation, tissue palpation, blunt dissection and retraction. The hand in the wound plays the role of the non-dominant hand in open surgery: It works in concert with the instrument-bearing hand for effective and safe tissue dissection. When bleeding occurs, the hand provides prompt and secure hemostasis, allowing exposure, clip application or suture ligature, lntracorporeal knot tying is similar to the technique used in open surgery. The learning curve appears to be less sleep for hand-assisted laparoscopy.


  1. 1. Stifelman MD, Sosa RE, Shichman SJ: Hand-Assisted La-paroscopy in Urology. Reviews in Urology, Spring 2001, 63-71.
  2. 2. Sosa RE, Nakada SY, Shichman S:Introduction to Laparo-scopy, 2001 AUA Annual Meeting Posgraduated Course, Anaheim 2001: 33-59
  3. 3. Schuessler WW, Vancaillie TG Reich H et al: Transperitoneal endosurgical lymphadenectomy in patients with localized prostate cancer. J Urol 1991; 145: 988.
  4. 4. dayman RV, Kavoussi LR, Soper NJ et al: Laparoscopic nephrectomy Letter. N Eng J Med 1991, 324:1370.
  5. 5. Kusminsky RE, Boland JP, Tiley EH, Deluca JA: Hand-assisted laparoscopic splenectomy. Surg Laparosc Endosc 1995; 5 (6): 463-7.
  6. 6. Tiemey JP: Hand-assisted laparoscopic nephrectomy. Min Inv Tech 1994; 5: 483.
  7. 7. Doublet JD, Baretto HS, Degremont AC, Gattegno B, Thi-bault P:Retroperitoneal nephrectomy: comparison oflaparo-scopy with open surgeiy. World J Surg 1996; 20: 713.
  8. 8. Rasswciler JJ, Stock C, Fred T, Seemann O, Henkel T Alken P: Transperitoneal and retroperitoneal laparoscopic nephrectomy in comparison with conventional nephrectomy. Uro-logeA1996;35:215.
  9. 9. Saadeh FM, Mulvin DW, Coker CB Coptcoat MJ: Laparoscope\\\' for renal cancer. J. Endourol. Suppl. 9, S99, abstract P-110, 1995.


Sławomir Paweł Woźniak
ul. Białoruska 10
54-425 Wrocław