Grasping and dissecting instrument for hand-assisted laparoscopic surgery

We read with great interest and pleasure about the efforts that had been made by A. Pietrabissa et al. to improve the possiblities of hand-assisted laparoscopic surgery (HALS), with a newly developed instrument. However, it surely will take considerable time until such special in- struments will be universally available, and affordable. Unfortunately, as a new method, HALS has had no dedicated manuals or instrumentation. With this com- ment, we would like to help those who also felt the need of such instruments, but did not have the means until now. In the past few years, since we began routinely using HALS for splenic, aortic, colonic, and renal sur- gery, we also realized that such instrumentation is useful. As a cheap and available solution, we were generally using either a small, atraumatic vascular clamp, a so- called bulldog, or a similar vascular hook, which are basic parts of the trays used for vascular surgery. Both are very useful when manipulating in close proximity to vascular structures, such as during hand-assisted live- donor nephrectomy. These instruments can be fixed to the wrist of the introduced hand. As both are atraumatic and have no sharp edges, we did not cover them while not in use and had no complications from that. In addition to this point, we also would like to offer another help for those just beginning HALS. With the introduction of a surgical towel into the abdomen through the hand port, clots can easily be wiped away or small bleedings compressed. In con- trast to irrigation–suction, this method leaves the field of the operation completely clean and clear, and the towel can also be changed more times. Based on our experience, it also is not emphasized enough that the surgeon must wear a darker colored glove on the hand introduced (brown), to prevent glare caused by the reflection of the light from a white surface. Until special manuals are available dedicated to HALS, we feel it is very important to share the experience of the practiced, and we hope that more and more articles will be published on the newest developments of HALS.