Prospective comparison of hand-assisted laparoscopic devices.
OBJECTIVES: To evaluate and compare the three commercially available first-generation hand-assisted laparoscopic (HAL) devices in a prospective, randomized fashion. HAL nephrectomy has become an increasingly popular surgical modality. METHODS: Sixty-seven board-certified urologists each performed two HAL nephrectomies in a porcine laboratory, using two different hand devices, at a learning course sponsored by the American Urological Association. At the completion of the laboratory session, each surgeon was asked to complete a 12-question survey designed to evaluate the different hand-assist devices. RESULTS: Thirty-nine surgeons used the HandPort, 47 used the Intromit, and 47 used the Pneumosleeve. No statistical differences were found in the ratings among the three devices within any category. No device scored better than 8.1 in any category, and the overall satisfaction was less than 7.7 in all three groups. Although not statistically significant, the Intromit device had the highest ratings in the following categories: instructions, maintenance of pneumoperitoneum, exchange of laparotomy pads, retrieval of specimens, sturdiness, and overall satisfaction. The HandPort had the highest failure rate. CONCLUSIONS: HAL relies heavily on devices that allow the hand to be introduced into the laparoscopic environment. The three available devices are all effective, yet each have their specific advantages and disadvantages. In terms of overall satisfaction, no device scored greater than 7.7. The results of this study suggest that the need for improvement by all three manufacturers is significant and have helped to better identify these areas.