The following section describes the HandPort’s use in assistance of laparoscopic subtotal and total gastrectomy with reconstruction. Gastrectomy cases serve as an excellent model to demonstrate the potential benefits of hand-assistance to advanced laparoscopic surgery. Since an extraction incision is often necessary in gastrectomy and other advanced cases, we simply make use of this incision from the beginning through a properly selected site. Making use of the operator’s hand from the start allows continued efficient retraction, blunt dissection, and tactile feedback throughout the case. We have had considerable total laparoscopic gastrectomy experience and believe this device will allow us to perform laparoscopic gastrectomy more safely and efficiently. Our bias is that the well-known benefits to the patient from the laparoscopic approach (less pain, quicker recovery) will, for the most part, be retained.

Patient Selection
Standard indications for gastrectomy are utilized. The laparoscopic approach may be used to treat both benign and malignant diseases of the stomach. In view of the current debate over laparoscopic surgery in cases of known malignancy, and, in particular, port site recurrence, caution must be exercised in patients with potentially curative resections. However, most examples of port site recurrence are likely the result of advanced disease or poor technique. We can not overemphasize enough the need to adhere to the strict surgical principles in which we individually believe. The laparoscopic equivalent should not be a compromise or short-cut procedure.

Contraindications to this approach remain as those encountered for most complex laparoscopic surgery, specifically, poor cardiopulmonary reserve. This is due to the decrease in venous return and increase in pulmonary resistance associated with the pneumoperitoneum. A relative contraindication may include non-elective gastric resection.