ABSTRACT
Originally, hand-assisted laparoscopy involved taking a gloved hand and placing it directly into the abdomen through a tight incision the size of ones wrist. This technique was used in colon surgery to extract the bowel and then place the proxi mal end with the anvil, and attach it to the stapler distally. Problems arose if the incision was too long and pneumoperitoneum could not be maintained. It was also difficult to rotate and move your hand in all directions and still maintain pneumo peritoneum. Surgeons would also suffer from hand fatigue given the tight geometry they had to work in. Several companies have invented devices that allow much greater movement while maintaining pneumoperitoneum. They also will allow you to re move your hand and operate through the incision. Two devices that work in mor bidly obese patients are the Pneumo Sleeve® (Lifequest, Rosewell, GA) and Handport® (Smith & Nephew, Andover, MA). The Pneumo Sleeve uses a protractor device to protect and open the incision along with a port that is temporarily glued to the skin around the incision. The sleeve is then placed on the surgeons nondominant hand and attached to the port. The Handport device, in contrast, uses a double inflatable collar that is placed in the incision to maintain pneumoperitoneum
and is then attached to the extra long sleeve that was placed around the surgeons nondominant hand.
