HAND-ASSISTED LAPAROSCOPIC IN UROLOGY CASES : FIRST INDONESIA

EXPERIENCE

Dr. Rahmat Syahili1, Dr. dr. Eriawan Agung Nugroho, SpU2, Dr. Ardy Santosa, Sp.U2, Dr.
Nanda Daniswara, Sp.U2, Dr. Sofyan Rais A2, Sp. U, Dr. Antonio Paulus1
1
Resident of General Surgery, Medical Faculty of Diponegoro University/dr. Kariadi Hospital Semarang,
Indonesia
2
Staff of Urology Department, Medical Faculty of Diponegoro University/dr. Kariadi Hospital Semarang,
Indonesia

ABSTRACT

Introduction : Minimally invasive renal surgery has became popular. Laparoscopists have

already fond of hand-assisted laparoscopic (HAL). The benefits of less pain and a quick

recovery associated with laparoscopic approach compared to traditional flank incision are

well documented.

Case Presentation : There was three urology cases was managed with hand assisted

laparoscopy in Kariadi Hospital on December 2018, a 63 year-old female with right kidney

mass undergone hand-assisted laparoscopic partial nephrectomy, a 61 year old female with

bilateral multiple kidney cysts, and a 53 year old male with right giant kidney cyst undergone

hand-assisted laparoscopic kidney cyst unroofing. All cases showed good outcome.

According to our experience, even though hand assisted laparoscopy in urology has been done

since two decades ago, these three cases were the first time done in Indonesia.

Discussion : Hand-assisted laparoscopy (HAL) in urology utilizes all the principles of

standard transperitoneal laparoscopy. The difference is that the surgeons are also able to insert

their hand into the operative field. This technique has allowed the laparoscopist to use of the

surgeon’s hand, for exposing, retracting, dissecting, and maintaining hemostasis. The detail

seen by visualization in HAL was superior to that seen with direct examination through open

abdomen because of closeness of the lens and magnification by by the laparoscopic video

imaging.
Conclusion : Hand-assisted laparoscopy is safe, minimally invasive and reproducible to

perform renal surgery. There are clear advantages over traditional open surgery including less

blood loss, pain medication needed, and hospital length of stay.

Keywords : hand-assisted laparoscopy, renal surgery, endourology, Indonesia