PubMed · 7288353
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I Kawabata, Y Nomura, S Shuto. 1981. Microdissection within SEM using new micromanipulator.. https://pubmed.ncbi.nlm.nih.gov/7288353/
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BACKGROUND: Although several reports have subjectively highlighted the benefits of hand-assisted as compared with conventional laparoscopic surgery, there has been little objective analysis comparing these two techniques. METHODS: For this study, 12 trained laparoscopic surgeons completed standardized knot-tying and dissection tasks in a laparoscopic trainer using both hand-assisted (HandPort) and traditional laparoscopic techniques. Motion analysis with the Imperial College Surgical Assessment Device was used to assess performance, measuring the number of movements made, the path length of hand travel, and the time taken. Mann-Whitney U tests were used to compare hand-assisted (HA) and conventional laparoscopic (L) performance. A p value less than 0.05 was deemed significant. Means and standard deviations are shown in the results. RESULTS: In knot tying, for both the dominant and nondominant hands, hand-assisted rather than conventional laparoscopic techniques resulted in reduced movements (dominant: HA [114 +/- 50] vs L [321 +/- 118, p < 0.001], nondominant: HA [89 +/- 36] vs L [296 +/- 96, p < 0.001]); path length (dominant: HA [1,083 +/- 680 mm] vs L [3,637 +/- 1,852 mm, p < 0.001], nondominant: HA [549 +/- 339 mm] vs L [2,556 +/- 1,042 mm, p < 0.001]); and time taken (HA [162 +/- 50 s] vs L [460 +/- 179 s, p < 0.001]). However, there was no statistical difference for any measured variable with respect to the dissection task. CONCLUSION: Hand-assisted surgery significantly improves the knot-tying ability among trained laparoscopic surgeons. However, there appears to be no improvement in performance for this specific dissection task.
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During regular dissection of the retroperitoneal region, three uncommon anatomical variations of the internal iliac veins were found on dissected specimens: in the first case, the internal iliac veins converge forming a common trunk draining into the left external iliac vein. In the other two cases, the internal iliac vein crosses the median plane and flows into the contralateral common iliac vein. These anomalies result from a persistence of the embryonic inferior branch of the cardinal vein and are important to be known for they may be undetected or may not appear in imaging. These data have implications for both pelvic surgeons and anatomists who manipulated this anatomical area.