Hand-assisted laparoscopic techniques - is there any benefit?

Introduction

Laparoscopic procedures are well established in equine surgery, nonetheless the development of new techniques is in an ongoing progress. For hand-assisted laparoscopy (HALS) several indications have been described in literature, such as gynaecological interventions like, ovariectomy (1,2), ovariohysterectomy (3), uterine tear closure (4-6) and uterine neoplasia removal (7,8). HALS can also be used for abdominal adhesiolysis, intestinal resections (9), suturing of mesenteric rents (10) or rectal tears (11) and nephrosplenic space closure with or without repositioning of the large colon (12,13) is a common surgical intervention in many equine hospitals. Concerning the urine tract nephrectomy (14-20) and removal of uroliths (21) by HALS has also been described.

The benefits of HALS in standard laparoscopy should be questioned and be compared to solely laparoscopic techniques and alternative approaches to improve surgical standards and achieve the best results for the patients.

Limitations of standard laparoscopy

Limitations of standard laparoscopy are, that tissue handling with laparoscopic instruments require advanced skills and depends on availability of specialized instruments according to the intraoperative situation. The size and weight especially of the large intestine makes manipulation of this structure difficult or even impossible. Furthermore, the positioning and size of the laparoscopic portals can represent a limitation to movement and removal of organs or biopsies through the small incisions. [...]