However, these investigators have demonstrated that the hand pain, experienced by some surgeons during hand-assisted laparoscopy (HAL), may be due to ischemia secondary to the pneumoperitoneum. Unfortunately, we do not know how many urologists participated in this study or whether there was a correlation between increased age and hand pain during HAL. However, those surgeons who had experienced hand pain during HAL in clinical experience were found to have a significant reduction in oxygen saturation as measured by an oxygen sensor attached to the non-dominant index finger during an experimental hand-assisted laparoscopy with pneumoperitoneum of 15 mmHg, compared to those surgeons who had not experienced hand pain during HAL. In addition, during the observed hypoxic episodes these surgeons reported significantly higher pain scores for the hand in the HAL port. The hypoxia and hand pain became most pronounced after 24 minutes of established pneumoperitoneum. It may be very prudent for HAL surgeons to remove their hands from the HAL port if they experience pain to relieve this hypoxic event. Additionally it was unfortunate, these researchers did not document how long it takes for the hypoxia and the hand pain to resolve once removed from the pneumoperitoneum.

Michael C. Ost, Brian A. VanderBrink, Ardeshir R. Rastinehad, Arthur D. Smith,and Benjamin R. Lee

J Urol 176 (1): 149-154, 2006

Written by Elspeth M. McDougall, MD, a Contributing Editor with UroToday.

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