Surgical Endoscopy

, Volume 22, Issue 3, pp 739–743 | Cite as

Hand-assisted versus laparoscopic-assisted colorectal surgery: Practice patterns and clinical outcomes in a minimally-invasive colorectal practice

  • Imran Hassan
  • Y. Nancy You
  • Robert R. Cima
  • David W. Larson
  • Eric J. Dozois
  • S. A. Barnes
  • John H. Pemberton



Laparoscopic assisted (LA) colectomy has significant patient benefits but is technically challenging. Hand-assisted laparoscopic surgery (HALS) allows tactile feedback because the surgeon’s hand assists in retraction and dissection. This may decrease the technical difficulty and shorten the learning curve associated with performing laparoscopic colectomy. We investigated the patient selection and short-term clinical outcomes of HALS and LA since the introduction of HALS to our minimally invasive colorectal practice.


Prospectively collected data on 258 patients undergoing HALS (n = 109) or LA colectomy (n = 149) during a calendar year (2004) were analyzed. Patient and disease characteristics, operative parameters, and perioperative outcomes were compared.


HALS patients were similar to LA patients in age (51 vs. 54 yrs), gender (56 vs. 52% male), body mass index (26 vs. 26 kg/m2), comorbidities (84 vs. 85% with one or more), and diagnosis (83 vs. 80% benign), but differed in incidence of previous surgery (49 vs. 30%; P = 0.008). A significantly greater proportion of HALS patients underwent complex procedures and extensive resections. Conversion rates (15 vs. 11%, P = 0.44), intraoperative complications (4 vs. 1%, P = 0.17), 30-day morbidity (18 vs. 11%, P = 0.12) and surgical reinterventions (2 vs. 1%, P = 0.58) did not differ. Recovery measured by days to flatus was not different [mean (standard deviation) 3(2) vs. 3(2) days, P = 0.26], however HALS patients had longer operative times [276(96) vs. 211(107) minutes P < 0.0001] and 1 day longer stay in hospital [6(3) vs. 5 (3) days, P = 0.0009)].


Patients undergoing HALS underwent more-complex procedures than LA patients but retained the short-term benefits associated with LA colectomy. HALS facilitates expansion of a minimally invasive colectomy practice to include more challenging procedures while maintaining short-term patient benefits.


Colorectal cancer Clinical papers Instrumental Technics Bowel 


  1. 1.
    Hand-assisted laparoscopic surgery vs. standard laparoscopic surgery for colorectal disease: a prospective randomized trial. (2000) HALS study group. Surg Endosc 14(10):896–901Google Scholar
  2. 2.
    Larson DW, Cima RR, Dozois EJ, et al. (2006) Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis: a single institutional case-matched experience. Ann Surg 243(5):667–670; discussion 670–672PubMedCrossRefGoogle Scholar
  3. 3.
    Noel JK, Fahrbach K, Estok R, et al. (2007) Minimally invasive colorectal resection outcomes: Short-term comparison with open procedures. J Am Coll Surg 204(2):291–307PubMedCrossRefGoogle Scholar
  4. 4.
    Lee SW, Yoo J, Dujovny N, et al. (2006) Laparoscopic vs. hand-assisted laparoscopic sigmoidectomy for diverticulitis. Dis Colon Rectum 49(4):464–469PubMedCrossRefGoogle Scholar
  5. 5.
    Meijer DW, Bannenberg JJ, Jakimowicz JJ (2000) Hand-assisted laparoscopic surgery: an overview. Surg Endosc 14(10):891–895PubMedCrossRefGoogle Scholar
  6. 6.
    Kurian MS, Patterson E, Andrei VE, et al. (2001) Hand-assisted laparoscopic surgery: an emerging technique. Surg Endosc 15(11):1277–1281PubMedCrossRefGoogle Scholar
  7. 7.
    Ballantyne GH, Leahy PF (2004) Hand-assisted laparoscopic colectomy: evolution to a clinically useful technique. Dis Colon Rectum 47(5):753–765PubMedCrossRefGoogle Scholar
  8. 8.
    Darzi A (2000) Hand-assisted laparoscopic colorectal surgery. Surg Endosc 14(11):999–1004PubMedCrossRefGoogle Scholar
  9. 9.
    Litwin DE, Darzi A, Jakimowicz J, et al. (2000) Hand-assisted laparoscopic surgery (HALS) with the HandPort system: initial experience with 68 patients. Ann Surg 231(5):715–723PubMedCrossRefGoogle Scholar
  10. 10.
    Maartense S, Bemelman WA, Gerritsen van der Hoop A, et al. (2004) Hand-assisted laparoscopic surgery (HALS): a report of 150 procedures. Surg Endosc 18(3):397–401PubMedCrossRefGoogle Scholar
  11. 11.
    Schadde E, Smith D, Alkoraishi AS, et al. (2006) Hand-assisted laparoscopic colorectal surgery (HALS) at a community hospital: a prospective analysis of 104 consecutive cases. Surg Endosc 20(7):1077–1082PubMedCrossRefGoogle Scholar
  12. 12.
    Kang JC, Jao SW, Chung MH, et al. (2007) The learning curve for hand-assisted laparoscopic colectomy: a single surgeon’s experience. Surg Endosc 21(2): 234–237PubMedCrossRefGoogle Scholar
  13. 13.
    Nakajima K, Lee SW, Cocilovo C, et al. (2004) Hand-assisted laparoscopic colorectal surgery using GelPort. Surg Endosc 18(1):102–105PubMedCrossRefGoogle Scholar
  14. 14.
    Kang JC, Chung MH, Chao PC, et al. (2004) Hand-assisted laparoscopic colectomy vs open colectomy: a prospective randomized study. Surg Endosc 18(4):577–581PubMedCrossRefGoogle Scholar
  15. 15.
    Maartense S, Dunker MS, Slors JF, et al. (2004) Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial. Ann Surg 240(6):984–991; discussion 991–992PubMedCrossRefGoogle Scholar
  16. 16.
    Chang YJ, Marcello PW, Rusin LC, et al. (2005) Hand-assisted laparoscopic sigmoid colectomy: helping hand or hindrance? Surg Endosc 19(5):656–661PubMedCrossRefGoogle Scholar
  17. 17.
    Delaney CP, Pokala N, Senagore AJ, et al. (2005) Is laparoscopic colectomy applicable to patients with body mass index >30? A case-matched comparative study with open colectomy. Dis Colon Rectum 48(5):975–981PubMedCrossRefGoogle Scholar
  18. 18.
    Nakajima K, Lee SW, Cocilovo C, et al. (2004) Laparoscopic total colectomy: hand-assisted vs standard technique. Surg Endosc 18(4):582–586PubMedCrossRefGoogle Scholar
  19. 19.
    Larson DW, Dozois EJ, Piotrowicz K, et al. (2005) Laparoscopic-assisted vs. open ileal pouch-anal anastomosis: functional outcome in a case-matched series. Dis Colon Rectum 48(10):1845–1850PubMedCrossRefGoogle Scholar
  20. 20.
    Hassan I, Pemberton JH, Young-Fadok TM, et al. (2006) Ileorectal anastomosis for slow transit constipation: long-term functional and quality of life results. J Gastrointest Surg 10(10):1330–1336; discussion 1336–1337PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Imran Hassan
    • 1
    • 2
  • Y. Nancy You
    • 2
  • Robert R. Cima
    • 2
  • David W. Larson
    • 2
  • Eric J. Dozois
    • 2
  • S. A. Barnes
    • 3
  • John H. Pemberton
    • 2
  1. 1.Division of General SurgerySIU School of MedicineSpringfieldUSA
  2. 2.Division of Colon and Rectal SurgeryMayo ClinicRochesterUSA
  3. 3.Section of BiostatisticsMayo ClinicRochesterUSA

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