Page 46 - World Journal of Laparoscopic Surgery

Technique for Left-handed Surgeons
Table 1: The results of this comparison are summarized in detail at the
table below.
Modified method Conventional method
Age 19–49 Y (mean 45.2 Y) 18–55 Y (mean 45.7 Y)
Sex (M/F) 17/23 12/28
Body mass index 18–30 (mean 26.9) 18–30 (mean 27.3)
Mean operative 29.2 58.7
time (min)
Requirement of No No
transfusions
Intraoperative No 2 cases Figs. 2A to C: Trocar placement (a1 is assistant): (A) standard trocar
complications placement by a right-handed surgeon in the French technique;
Conversion to No 1 case (B) Modification for trocar placement by the left-handed surgeon in the
open French technique; and (C) the figure shows how the surgeon uses an
atraumatic grasper in his right non-dominant hand to retract gallbladder
Port site infection No No fundus while his dominant hand is used to dissect the hilum. It is hoped
Hospital stay 1–2 days 1–2 days that the changes introduced to ease the burden on left-handed residents
Follow-up 6 months 6 months in residency training programs 5

After obtaining informed consent, forty surgeries using more comfort, security, and reduce the error rate for left-handed
the modified method are done by the author who himself is a surgeons. The only study in this regard is published by Mr. Herrero
left-handed general surgeon with experience of more than 200 and colleagues in the journal of Laparoendoscopic and Advanced
laparoscopic cholecystectomies, and forty surgeries are done Surgical Techniques. They suggest reforming the location of ports
5
using the standard American method by the same surgeon from to reduce the problems of left-handed surgeons. These reforms
August 2017 to August 2018. The patients with documented acute were done on the French model, while our study is a modification
cholecystitis, and choledocholithiasis, and biliary pancreatitis were for the American standard method (Fig. 2). Left-handed surgeons
excluded. Overweight patients (body mass index > 30) were also must learn to work in an environment suitable for right-hands and
excluded from the study. None of our patients had any history of with the right-handed made tools and using methods described
previous abdominal surgical intervention. Preoperative checkups, by the right-hands to have a safe and comfortable operation. It
such as CBC (complete blood count), kidney function tests, liver is not possible except through reforms, no matter how small the
function tests, ECG (electrocardiogram), chest radiograph, and modification procedure is so that they can grow their safety and
ultrasonography (confirmed the presence of gallbladder stones) was their comfort during operations and expand their skills in this
done. Preoperative prophylactic antibiotics were also given in all regard. The study will help achieve these goals.
patients. So this modified technique in comparison to the standard
method (American) that is taught to general surgery residents was AcknowledgMent
much smoother, faster, and with fewer side effects in the hands of
a left-handed surgeon (Table 1). This work was performed in the Endoscopic and Minimally Invasive
There were two complications (5%) totally and only in the Surgery Research Center, Mashhad University of Medical Sciences.
conventional method. Both were minor. One of them was diffuse We specially thank Ms Sima Beigoli for her assistance in preparing
hemorrhagic ooze from the liver bed and the other was bilious ooze from this article.
the gallbladder bed. The complications were managed intraoperatively
by supplying the proper hemostasis and prolonged drainage (10 days). references
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World Journal of Laparoscopic Surgery, Volume 14 Issue 1 (January–April 2021) 47