Article

Surgical Endoscopy And Other Interventional Techniques

, Volume 20, Issue 7, pp 1077-1082

First online:

Hand-assisted laparoscopic colorectal surgery (HALS) at a community hospital

A prospective analysis of 104 consecutive cases
  • E. SchaddeAffiliated withDepartment of Surgery, New England Medical Center/Tufts University School of Medicine
  • , D. SmithAffiliated withDepartment of Surgery, New England Medical Center/Tufts University School of Medicine
  • , A. S. AlkoraishiAffiliated withKaiser Hospital
  • , D. G. BegosAffiliated withCommonwealth Surgical Associates Email author 

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Abstract

Background

We report 104 consecutive cases of hand-assisted laparoscopic (HAL) colectomy over 5 years performed by a single surgeon.

Methods

Data were gathered prospectively and include patient demographic data, diagnosis, operating time, conversion rate, length of hospital stay, and complications. Virtually all patients presenting for elective resection with benign disease and metastatic cancer were treated using HAL techniques.

Results

The mean age was 61 years; 48% of patients had diverticulitis; 21%, colorectal cancer; 18%, benign polyps. In addition, 55% of patients underwent sigmoid or left colectomy; 27%; right hemicolectomy; 9%, low anterior resection, and two double resections were performed. Mean operating room time was 135 minutes; in 12% of the patients conversion to open surgery became necessary, in most cases requiring only a small extension of the HAL incision. Mean and median discharge was postoperative day 4 and postoperative day 3, respectively. There was 1 death (1%) and 21% of patients had complications, 12% of them major.

Conclusions

Hand-assisted laparotomy colectomy is a safe and effective procedure. The data in terms of length of hospital stay and operative time compare favorably with published data for conventional laparoscopic (CL) colectomy. Although further study is necessary, it appears that HALS confers all of the advantages of CL for colectomy, with no obvious drawbacks.

Keywords

Laparoscopy Hand-assisted laparoscopic surgery Abdominal surgery Colectomy Minimally invasive surgery Handoscopy Learning curve