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Michael D. Stifelman - One of the best experts on this subject based on the ideXlab platform.
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Comparison of Hand-Assisted Laparoscopy versus open and laparoscopic techniques in urology procedures: a systematic review and meta-analysis.
Journal of endourology, 2011Co-Authors: Jonas Wadström, Rhonda Estok, Amber Martin, Catherine J. Mercaldi, Michael D. StifelmanAbstract:BACKGROUND AND PURPOSE Hand-Assisted laparoscopic surgery (HALS) is an integral part of the urologist's armamentarium. We aimed to perform a comprehensive meta-analysis comparing HALS renal surgery with open and laparoscopic techniques. METHODS A systematic review and meta-analysis of HALS renal procedures (donor nephrectomy, nephrectomy, or nephroureterectomy) from 1996 to 2007 was performed. RESULTS Sixty-two studies of 30 donor nephrectomy, 21 radical nephrectomy, and 14 nephroureterectomy procedures in 5446 patients were included in the analysis. In donor nephrectomy, estimated blood loss (EBL) was statistically significant for HALS vs the open and laparoscopic cohorts, -69.0 mL (95% confidence interval [CI], -129.7, -8.2) and -40.1 mL (95% CI, -68.2, -12.0), respectively. Length of stay (LOS) was shorter compared with the open group, -1.7 days (95% CI, -2.3, -1.1). For nephroureterectomy, EBL (-29.9 mL (95% CI, -242.3, 182.5)), and LOS (-1.5 d [95% CI, -2.8, -0.3]) again favored HALS vs open procedures. Operating room (OR) time and warm ischemia time (WIT) were statistically significant in favor of HALS donor nephrectomy vs the laparoscopic cohort; -36.8 minutes (95% CI, -61.3, -12.3) and -1.3 minutes (95% CI, -1.8, -0.7), respectively. For radical nephrectomy, both EBL -232.9 mL (95% CI, -383.6, -82.2) and LOS -2.4 days (95% CI, -3.5, -1.3) were statistically significant, favoring HALS vs the open group. CONCLUSION We report the largest meta-analysis of HALS renal surgery to date. When compared with open surgery, HALS allows for a significant decrease in EBL and LOS. Compared with laparoscopic donor nephrectomy, HALS resulted in a significant decrease in blood loss, OR time, and WIT.
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Comparison of Hand-Assisted Laparoscopy Versus Open and Laparoscopic Techniques in Urology Procedures: A Systematic Review and Meta-analysis
The Journal of Urology, 2009Co-Authors: Jonas Wadström, Rhonda Estok, Katie Williams, Amber Martin, Michael D. StifelmanAbstract:Abstract Background and Purpose: Hand-Assisted laparoscopic surgery (HALS) is an integral part of the urologist's armamentarium. We aimed to perform a comprehensive meta-analysis comparing HALS renal surgery with open and laparoscopic techniques. Methods: A systematic review and meta-analysis of HALS renal procedures (donor nephrectomy, nephrectomy, or nephroureterectomy) from 1996 to 2007 was performed. Results: Sixty-two studies of 30 donor nephrectomy, 21 radical nephrectomy, and 14 nephroureterectomy procedures in 5446 patients were included in the analysis. In donor nephrectomy, estimated blood loss (EBL) was statistically significant for HALS vs the open and laparoscopic cohorts, −69.0 mL (95% confidence interval [CI], −129.7, −8.2) and −40.1 mL (95% CI, −68.2, −12.0), respectively. Length of stay (LOS) was shorter compared with the open group, −1.7 days (95% CI, −2.3, −1.1). For nephroureterectomy, EBL (−29.9 mL (95% CI, −242.3, 182.5)), and LOS (−1.5 d [95% CI, −2.8, −0.3]) again favored HALS vs o...
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HALS devices and operating room set-up: pearls and pitfalls.
Journal of endourology, 2004Co-Authors: Michael D. Stifelman, Rupa PatelAbstract:Although some surgeons maintain that such devices are not necessary, most prefer a Hand-assist device for the performance of Hand-Assisted Laparoscopy. The three devices now available are the Gelport, LapDisc, and Omniport. None is perfect, and the choice depends in part on surgeon preference and patient body habitus. Each has advantages and disadvantages, and there is room for improvement, especially in the ease of Hand removal and reinsertion, sturdiness and reliability, and ability to maintain the pneumoperitoneum. Beginning laparoscopic surgeons are advised to try all three devices and formulate their own opinions. As important as the Hand-assist device is the operating room set-up. The authors provide a checklist covering the imaging system, insufflation equipment, hemostatic generators, and instrumentation.
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Hand-Assisted Laparoscopy for large renal specimens: a multi-institutional study.
Urology, 2003Co-Authors: Michael D. Stifelman, R. Ernest Sosa, Toby Handler, Alan M. Nieder, Joseph J. Del Pizzo, Samir S. Taneja, Steven J. ShichmanAbstract:Abstract Objectives To present our experience with Hand-Assisted Laparoscopy (HAL) for larger renal specimens. One of the theoretical benefits of HAL is the ability to manage large renal specimens, which we defined as tumors greater than 7 cm, and tumors in obese patients. Methods Between March 1998 and October 2000, 106 HAL radical nephrectomies were performed for enhancing renal masses, for which 95 patients had complete preoperative, intraoperative, and postoperative data. Of the 95 patients, 32 underwent HAL for large tumors (7 cm or greater) and 41 had a body mass index of 31 or greater. The demographic and outcome data of these two groups were compared with 63 patients who underwent HAL for tumors less than 7 cm and 54 patients with a body mass index of less than 31. Results When comparing cohorts by tumor size, the only statistically significant differences were in convalescence and specimen weight. Patients with lesions 7 cm or greater required 21 days to recover compared with 18 days for patients with lesions less than 7 cm. Obese patients had statistically significantly higher American Society of Anesthesiologists classifications, longer operative times (214 versus 176 minutes), and longer convalescences (21 versus 17.5 days) compared with nonobese patients. The estimated blood loss and conversion rate was not different between the groups. Furthermore, no difference was noted between the groups in the incidence of positive margins, local recurrence, or metastatic recurrence at a mean follow-up of 12.2 months. Conclusions HAL provides a safe, reproducible, and minimally invasive technique to remove large renal tumors and renal tumors in the obese.
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Hand Assisted laparoscopic donor nephrectomy: a comparison with the open approach.
The Journal of urology, 2001Co-Authors: Michael D. Stifelman, R. Ernest Sosa, David Hull, Michael J. Hyman, William T. Stubenbord, Steven ShichmanAbstract:Purpose: Hand Assisted Laparoscopy combines aspects of open and laparoscopic surgery. A Hand in the abdomen may facilitate laparoscopic live donor nephrectomy, allowing more urologists to participate. We report and compare our initial series of Hand Assisted Laparoscopy donor nephrectomy with nephrectomy performed by standard open methods.Materials and Methods: In the last 18 months 60 patients at 2 institutions underwent Hand Assisted Laparoscopy donor nephrectomy. This cohort was compared to a contemporary group of 31 patients who underwent open donor nephrectomy via a flank incision at our 2 institutions. Demographic and outcome data were compared retrospectively in a nonrandomized fashion in the 2 groups.Results: Demographic data on patient age, male-to-female ratio and body mass index were similar in the 2 groups. Operative time, transfusion rate, time to oral intake and complications were also similar. However, estimated blood loss, change in hematocrit preoperatively to postoperatively, hospitaliza...
Howard N. Winfield - One of the best experts on this subject based on the ideXlab platform.
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SURVEY OF UROLOGICAL LAPAROSCOPIC PRACTICE PATTERNS IN THE MIDWEST
The Journal of Urology, 2004Co-Authors: David S. Wang, Howard N. WinfieldAbstract:ABSTRACTPurpose: Laparoscopic surgery is assuming a greater role in the management of many urological disorders. We performed a survey of urologists in the Midwest United States to define laparoscopic practice patterns regarding urological disease.Materials and Methods: Surveys were mailed to 1,450 members of the North Central Section of the American Urological Association. Questions pertained to age, practice demographics, residency training and amount of Laparoscopy performed.Results: A response rate of 33% was obtained. A total of 49% of urologists perform no Laparoscopy, 30% devote less than 5% of their practice and 21% devote 5% or more of their practice to Laparoscopy. Of the responders 15% believed they were adequately trained during residency to perform Laparoscopy. Among those who performed Hand Assisted Laparoscopy (HAL), 52% used it to gain familiarity with laparoscopic techniques. There was an inverse correlation between time in practice and amount of Laparoscopy performed (p
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Survey of Urological Laparoscopic Practices in the State of California
The Journal of urology, 2002Co-Authors: Ayal M. Kaynan, Keith L. Lee, Howard N. WinfieldAbstract:Purpose: In the interest of maintaining our surgical domain we performed a survey aimed at establishing laparoscopic practice patterns as they pertain to urological disease.Materials and Methods: Surveys were mailed to 2,902 surgeons in California who were listed with the American College of Surgeons, including 2,175 general surgeons, 510 urologists and 217 obstetricians-gynecologists.Results: A total of 442 complete responses (15.2%) were tallied. Of urologists and of nonurologists 54% and 11% performed no Laparoscopy, while 12% and 80%, respectively, devoted at least 5% of their time to laparoscopic surgery. Urologists and nonurologists performing no Laparoscopy were older than those performing a significant volume (p < 0.05). Of urologists 16% thought that they were trained adequately during residency to perform laparoscopic surgery compared with 30% of nonurologists. Of the urologists who performed Hand Assisted Laparoscopy 50% tended to use it as a means of gaining familiarity with these techniques. ...
J. Stuart Wolf - One of the best experts on this subject based on the ideXlab platform.
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Risk Factors for Conversion to Hand Assisted Laparoscopy or Open Surgery During Laparoscopic Renal Surgery
The Journal of urology, 2011Co-Authors: Michael W. Rowley, J. Stuart WolfAbstract:Purpose: Risk factors for conversion to Hand Assisted laparoscopic or open surgery during laparoscopic renal surgery are incompletely defined.Materials and Methods: We reviewed our institutional database of 759 standard laparoscopic and 833 Hand Assisted laparoscopic radical, simple, donor and partial nephrectomies, pyeloplasties and nephroureterectomies from June 1996 to February 2009, representing a total of 1,592 cases. We identified the incidence of and indications for conversion to Hand Assisted laparoscopic and open surgery, and determined risk factors for conversion.Results: Of all 1,592 procedures 20 (1.3%) required conversion to open surgery. Of 759 standard laparoscopic procedures 21 (2.8%) were converted to Hand Assisted laparoscopic surgery and 1.7% were converted to open surgery for an overall standard Laparoscopy conversion rate of 4.6%. Only 0.7% of Hand Assisted laparoscopic procedures were converted to open surgery. The rate of conversion to open surgery ranged from 0.3% for laparoscopic ...
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The role of Hand-Assisted Laparoscopy in urology: a critical appraisal
BJU international, 2005Co-Authors: Abhay Rane, J. Stuart WolfAbstract:Several devices are commercially manufactured which allow the Hand to be introduced into an insufflated abdomen while maintaining the pneumoperitoneum. The Pneumosleeve® (Dexterity Inc., Atlanta, USA) was the first device, introduced in 1997. The Intromit® (Applied Medical, Rancho Santa Margarita, USA) and the HandPort® (Smith and Nephew, Huntingdon, UK) followed shortly thereafter, but all have been discontinued in favour of the three superior ‘second-generation’ products currently available.
Herand Abcarian - One of the best experts on this subject based on the ideXlab platform.
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incisional hernia midline versus low transverse incision what is the ideal incision for specimen extraction and Hand Assisted Laparoscopy
Surgical Endoscopy and Other Interventional Techniques, 2011Co-Authors: Ashwin L Desouza, Bastian Domajnko, John J Park, Slawomir J Marecik, Leela M Prasad, Herand AbcarianAbstract:Background Minimally invasive surgery is associated with smaller surgical incisions than those of traditional midline laparotomy. However, most colorectal resections and all Hand-Assisted procedures require an incision either for specimen retrieval or insertion of the Hand-assist device. The ideal site of this incision has not been evaluated with respect to the incidence of incisional hernia. This study compares the rates of incisional hernia associated with a standard midline laparotomy, a midline incision of reduced length, and a Pfannenstiel incision.
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Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and Hand-Assisted Laparoscopy?
Surgical Endoscopy, 2011Co-Authors: Ashwin Desouza, Bastian Domajnko, Slawomir J Marecik, John Park, Leela Prasad, Herand AbcarianAbstract:Background Minimally invasive surgery is associated with smaller surgical incisions than those of traditional midline laparotomy. However, most colorectal resections and all Hand-Assisted procedures require an incision either for specimen retrieval or insertion of the Hand-assist device. The ideal site of this incision has not been evaluated with respect to the incidence of incisional hernia. This study compares the rates of incisional hernia associated with a standard midline laparotomy, a midline incision of reduced length, and a Pfannenstiel incision. Methods From March 2004 to July 2007, 512 consecutive patients were identified from a prospectively maintained database according to predefined inclusion and exclusion criteria. Patients were divided into three groups depending on the type of incision (open, midline, and Pfannenstiel). Demographic variables, rate of incisional hernia, and risk factors for hernia were compared among the groups. Results There were 142, 231, and 139 patients in the open, midline, and Pfannenstiel groups, respectively. All three groups were comparable with respect to age, gender, steroid use, diabetes, number of patients with malignancy, and duration of follow-up. The Pfannenstiel group had a higher mean BMI ( p = 0.015) and the open group had a higher rate of wound infection (28.2%) compared to the other groups. Incidence of incisional hernia was similar for the open and midline groups (19.7 and 16%, p = 0.36). At a mean follow-up of 17.5 months, not a single patient with a Pfannenstiel incision developed an incisional hernia ( p
David M. Albala - One of the best experts on this subject based on the ideXlab platform.
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Hand Assisted laparoscopic training for postgraduate urologists: the role of mentoring.
The Journal of urology, 2004Co-Authors: Charles G. Marguet, Matthew D. Young, James O. L’esperance, Yeh Hong Tan, Wesley Ekeruo, Glenn M. Preminger, David M. AlbalaAbstract:ABSTRACTPurpose:: Hand Assisted Laparoscopy (HAL) has recently been accepted as a safe alternative for nephrectomy. HAL courses have been offered at several institutions to train novice laparoscopic surgeons in this minimally invasive surgical procedure. Mentoring by a course instructor or an experienced laparoscopist provides assistance to surgeons with their initial operation. However, to our knowledge the impact of mentoring on the clinical practice of HAL is not known. Therefore, we evaluated the clinical practice patterns of urologists following a postgraduate HAL course, comparing course graduates who underwent subsequent mentoring with those who were not mentored.Materials and Methods:: A total of 71 urologists attended a postgraduate training course in HAL at our institution between March 2002 and October 2002. Graduates were given the opportunity for one of the instructors to travel to their home institution and mentor them during their initial case(s). Followup surveys were mailed to the graduat...
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Hand-Assisted urological Laparoscopy.
Current opinion in urology, 2002Co-Authors: Paul K. Pietrow, David M. AlbalaAbstract:Hand-Assisted Laparoscopy has been successfully applied to various applications within the field of urology. Many authors have proved the safety and efficacy of this technique, as well as demonstrating improved patient recovery for such procedures as radical nephrectomy, radical nephroureterectomy and donor nephrectomy. The recent literature regarding this topic is reviewed and evaluated here.
