Skip to main content
SpringerLink
Log in

Functional and clinical outcomes of hand-assisted laparoscopic colorectal surgery: a single-institution experience in 255 patients

Hand-assisted laparoscopic surgery: single-center experience

  • Original Article
  • Published:
European Surgery Aims and scope Submit manuscript

Summary

Background

Hand-assisted laparoscopic colectomy is an alternative technique to laparoscopy: it is technically easier, learning curve and operative time is shorter. We aimed to describe the characteristics of patients admitted due to colorectal cancer for hand-assisted laparoscopic surgery (HALS), intra- and postoperative clinical and functional outcomes.

Methods

A prospectively maintained database was used to identify all patients who underwent HALS for colorectal cancer at the National Cancer Institute from April 2006 to November 1 2014. Data are presented as frequency (proportion) or median (interquartile range).

Results

A total of 255 HALS colorectal resections were performed. The mean HALS time was 105 min (50–270). The conversion rate was 1.96 % (5/255). The average number of lymph nodes harvested was 15 (2–54). The average time to first flatus was 1.92 days (1.5–4.5), to tolerance of solid food was 2.85 (1.4–3.4), and to first bowel movements was 3.64 (2.6–4.3). The median length of hospital stay was 6.8 days (3–31). Postoperative complication rate was 9.8 %. Three patients (1.17 %) demanded explorative laparotomy. Postoperative mortality rate was 0.39 % (one patient). There was 3.2 % of local recurrence in the colon and 5.8 % in the rectum and no port site metastasis during 36.3 (1–108) months of surveillance. The 3-year survival rates were 100 % for stage I, 97 % for stage II, 84 % for stage III, and 50 % for stage IV colorectal cancer.

Conclusions

Hand-assisted laparoscopic colorectal resection preserves nearly all the benefits of laparoscopic colectomy reported in the literature. With experience, it is associated with improved clinical outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Schiessel R. The development of sphincter saving surgery for rectal cancer: the long way from a perineal colostomy to restoration of continence. Eur Surg. 2014;46:79–84.

    Article  Google Scholar 

  2. Boland JP, Kuminsky RE, Tiley EH. Laparoscopic minilaparotomy with manipulation: the middle path. Minim Invasive Surg. 1993;2:263–7.

    Google Scholar 

  3. Pendlimari R, Holubar SD, Pattan-Arun J, et al. Hand-assisted laparoscopic colon and rectal cancer surgery: feasibility, short-term, and oncological outcomes. Surgery. 2010;148:378–85.

    Article  PubMed  Google Scholar 

  4. Marcello PW, Fleshman JW, Milsom JW, et al. Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial. Dis Colon Rectum. 2008;51:818–29.

    Article  PubMed  Google Scholar 

  5. Cima RR, Pattana-Arun J, Larson DW, et al. Experience with 969 minimal access colectomies: the role of hand-assisted laparoscopy in expanding minimally invasive surgery for complex colectomies. J Am Coll Surg. 2008;206:946–52.

    Article  PubMed  Google Scholar 

  6. Pendlimari R, Holubar SD, Dozois EJ, et al. Technical proficiency in hand-assisted laparoscopic colon and rectal surgery: determining how many cases are required to achieve mastery. Arch Surg. 2012;147:317–22.

    Article  PubMed  Google Scholar 

  7. Ozturk E, da Luz Moreira A, Vogel JD. Hand-assisted laparoscopic colectomy: the learning curve is for operative speed, not for quality. Colorectal Dis. 2010;12:304–9.

    Article  Google Scholar 

  8. Ozturk E, Kiran RP, Geisler DP, et al. Hand-assisted laparoscopic colectomy: benefits of laparoscopic colectomy at no extra cost. J Am Coll Surg. 2009;209:242–7.

    Article  PubMed  Google Scholar 

  9. Cima R, Pendlimari R, Holubar S, et al. Utility and short-term outcomes of hand-assisted laparoscopic colorectal surgery: a single-institution experience in 1103 patients. Dis Colon Rectum. 2011;54:1076–81.

    Article  PubMed  Google Scholar 

  10. HALS Study Group. Hand-assisted laparoscopic surgery vs. standard laparoscopic surgery for colorectal disease: a prospective randomized trial. Surg Endosc. 2000;14:896–901.

    Article  Google Scholar 

  11. Maartense S, Bemelman WA, van der Hoop GA, et al. Hand assisted laparoscopic surgery (HALS): a report of 150 procedures. Surg Endosc. 2004;18:397–401.

    Article  CAS  PubMed  Google Scholar 

  12. Aalbers AG, Biere SS, van Berge Henegouwen MI, et al. Hand-assisted or laparoscopic-assisted approach in colorectal surgery: a systematic review and meta-analysis. Surg Endosc. 2008;22:1769–80.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Iqbal M, Bhalerao S. Current status of hand-assisted laparoscopic colorectal surgery: a review. J Laparoendosc Adv Surg Tech A. 2007;17:172–9.

    Article  PubMed  Google Scholar 

  14. Schadde E, Smith D, Alkoraishi AS, et al. Hand-assisted laparoscopic colorectal surgery (HALS) at a community hospital: a prospective analysis of 104 consecutive cases. Surg Endosc. 2006;20:1077–82.

    Article  CAS  PubMed  Google Scholar 

  15. Dowson HM, Huang A, Soon Y, Gage H, et al. Systematic review of the costs of laparoscopic colorectal surgery. Dis Colon Rectum. 2007;50:908–19.

    Article  PubMed  Google Scholar 

  16. Lee JE, Joh YG, Yoo SH, et al. Long-term outcomes of laparoscopic surgery for colorectal cancer. J Korean Soc Coloproctol. 2011:27;64–70.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Reibetanz J, Germer CT. Lebensqualitat nach laparoskopischer vs. offener Rektumkarzinomchirurgie. Der Chirurg. 2014;85:154.

  18. Furst A, Heiligensetzer A, Sauer P, Liebig-Horl G. Evidenzlage der laparoskopischen Chirurgie beim Rektumkarzinom. Der Chirurg. 2014;85:578–82.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. National Cancer Institute, 1 Santariskiu Str, LT–08406, Vilnius, Lithuania

    A. Dulskas Jr., A. Kilius, K. Petrulis & R. Tikuisis

  2. Center of Oncosurgery, Clinic of Internal, Family Medicine and Oncology, Faculty of Medicine, National Cancer Institute, 1 Santariskiu Str., LT–08406, Vilnius, Lithuania

    N.E. Samalavicius

  3. Department of Surgery, Gastrointestinal unit, B.P. Koirala Institute of Health Sciences, Dharan, Nepal

    R.K. Gupta

  4. Second Department of Anesthesia, Intensive Care and Pain Management, Vilnius University Hospital Santariskiu Clinics, 2 Santariskiu Str., LT–08661, Vilnius, Lithuania

    R.S. Samalavicius

Authors
  1. A. Dulskas Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N.E. Samalavicius
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R.K. Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Kilius
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Petrulis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R.S. Samalavicius
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Tikuisis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Dulskas Jr..

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dulskas, A., Samalavicius, N., Gupta, R. et al. Functional and clinical outcomes of hand-assisted laparoscopic colorectal surgery: a single-institution experience in 255 patients. Eur Surg 47, 75–80 (2015). https://doi.org/10.1007/s10353-015-0308-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10353-015-0308-x

Keywords

Search

Navigation