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Diseases of the Colon & Rectum

, Volume 47, Issue 5, pp 753–765 | Cite as

Hand-Assisted Laparoscopic Colectomy: Evolution to a Clinically Useful Technique

  • Garth H. Ballantyne
  • Patrick F. Leahy
Current Status

PURPOSE:

Hand-assisted laparoscopic colectomy has traversed three phases of distinct development. This review was designed to trace the evolution of hand-assisted colectomy from an infrequently used technique to a clinically useful surgical approach to diseases of the colon and rectum.

METHODS:

This review compiles previously reported and published experiences with hand-assisted laparoscopic colectomy.

RESULTS:

During the first phase of development of hand-assisted laparoscopic colectomy, surgeons explored what could be accomplished by a hand inserted into the abdomen through the specimen extraction site as an adjunct to laparoscopic techniques. Case reports and small trials found that manually assisted laparoscopic techniques permitted more rapid completion of laparoscopic-assisted colectomies. In the second phase, surgeons used early devices that facilitated the insertion of the surgeon’s hand into the abdomen and helped to maintain the pneumoperitoneum. Larger series and small, randomized trials indicated a time-saving advantage to hand-assisted techniques and similar short-term outcomes as laparoscopic-assisted colectomies. In the current third phase, surgeons are using a new generation of hand-access devices that extend the options for hand-assisted techniques. These devices, like earlier devices, facilitate hand insertion, protect the wound, act as the retrieval site for the specimen, and serve as the portal for construction of extracorporeal anastomoses. In addition, these new devices can serve as laparoscopic trocar sites. This permits selective use of hand-assisted and laparoscopic-assisted techniques at various times in the same operation. These new devices have not undergone clinical trials, and therefore, a final appraisal must await future publication of outcomes.

CONCLUSIONS:

Hand-assisted laparoscopic colectomy has evolved into a clinically useful surgical technique. New devices facilitate the performance of these operations and permit the surgeon to switch between hand-assisted and laparoscopic techniques.

Keywords

Hand-assisted Manually assisted Laparoscopy Colectomy Colon Laparoscopic-assisted colectomy Hand-assisted laparoscopic colectomy Minimally invasive surgery Diverticulitis 

REFERENCES

  1. 1.
    Jacobs, M, Veredeja, JC, Goldstein, HS 1991Minimally invasive colon resection (laparoscopic colectomy)Surg Laparosc Endosc114450Google Scholar
  2. 2.
    Fowler, DC, White, SA 1991Brief clinical report: laparoscopic-assisted sigmoid resectionSurg Laparosc Endosc1183Google Scholar
  3. 3.
    Sgambati, SA, Ballantyne, GH 1996History of minimally invasive surgeryJager, RMWexner, SD eds. Laparoscopic colorectal surgeryChurchill LivingstoneNew York1323Google Scholar
  4. 4.
    4 Lo P, Ahmed N, Chung RS. Which laparoscopic operations are the fastest growing in residency programs [meeting abstract]? Presented at SAGES, April, 2001, St. Louis, P206.Google Scholar
  5. 5.
    Cirocco, WC, Schwartman, A, Golub, RW 1994Abdominal wall recurrence after laparoscopic colectomy for colon cancerSurgery11684246Google Scholar
  6. 6.
    Wexner, SD, Cohen, SM 1995Port site metastases after laparoscopic colorectal surgery for cure of malignancyBr J Surg8229598Google Scholar
  7. 7.
    Young-Fadok, TM 2002Review of laparoscopic-assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomized trialAm J Oncol Rev12013Google Scholar
  8. 8.
    Jakimowicz, JJ 2000Will advanced laparoscopic surgery go hand-assisted?Surg Endosc148812Google Scholar
  9. 9.
    Wishner, JD, Baker, JW,Jr, Hoffman, GC,  et al. 1995Laparoscopic-assisted colectomy. The learning curveSurg Endosc9117983Google Scholar
  10. 10.
    Senagore, AJ, Luchtefeld, MA, Mackeigan, JM 1995What is the learning curve for laparoscopic colectomy?Am Surg616815Google Scholar
  11. 11.
    Bennett, CL, Stryker, SJ, Ferreira, MR, Adams, J, Beart, RW,Jr 1997The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomiesArch Surg132414Google Scholar
  12. 12.
    Schlachta, CM, Mamazza, J, Seshadri, PA, Cadeddu, M, Gregoire, R, Poulin, EC 2001Defining a learning curve for laparoscopic colorectal resectionsDis Colon Rectum4421722Google Scholar
  13. 13.
    Ballantyne, GH 1995Laparoscopic-assisted colorectal surgery: review of results in 752 patientsGastroenterologist37589Google Scholar
  14. 14.
    Hyman, N 2002How much colorectal surgery do general surgeons do?J Am Col Surg194379Google Scholar
  15. 15.
    Kavic, MS 2001Hand-assisted laparoscopic surgery – HALSJ Soc Laparoendoscopic Surg51013Google Scholar
  16. 16.
    Kurian, MS, Patterson, E, Andrei, VE, Edye, MB 2001Hand-assisted laparoscopic surgery: an emerging techniqueSurg Endosc15127781Google Scholar
  17. 17.
    Darzi, A 2001Hand-assisted laparoscopic colorectal surgerySem Laparosc Surg815360Google Scholar
  18. 18.
    Cooperman, A 2000Laparoscopic-assisted ileocolectomy for inflammatory bowel diseaseBallantyne, GH eds. Atlas of laparoscopic surgeryWB SaundersPhiladelphia30815Google Scholar
  19. 19.
    Darzi, A 2000Hand-assisted laparoscopic colorectal surgerySurg Endosc1499104Google Scholar
  20. 20.
    Romanelli, JR, Kelly, JJ, Litwin, DE 2001Hand-assisted laparoscopic surgery in the United States: an overviewSem Laparosc Surg896103Google Scholar
  21. 21.
    Boland, JP, Kusminsky, RE, Tiley, EH 1993Laparoscopic mini-laparotomy with manipulation: the middle pathMinim Invasive Ther2637Google Scholar
  22. 22.
    Kusminsky, RE, Boland, JP, Tiley, EH 1996Hand-assisted laparoscopic surgery (letter)Dis Colon Rectum39111Google Scholar
  23. 23.
    Dunn, DC 1994Digitally assisted laparoscopic surgeryBr J Surg81474Google Scholar
  24. 24.
    Ou, H 1995Laparoscopic-assisted mini laparotomy with colectomyDis Colon Rectum383246Google Scholar
  25. 25.
    O’Reilly, MJ, Saye, WB, Mullins, SG, Pinto, SE, Falkner, PT 1996Technique of hand-assisted laparoscopic surgeryJ Laparoendoscopic Surg623944Google Scholar
  26. 26.
    Fleshman, JW, Fry, RD, Birnbaum, EH, Kodner, IJ 1996Laparoscopic-assisted and minilaparotomy approaches to colorectal diseases are similar in early outcomeDis Colon Rectum391522Google Scholar
  27. 27.
    Mooney, MJ, Elliott, PL, Galapon, DB, James, LK, Lilac, LJ, O’Reilly, MJ 1998Hand-assisted laparoscopic sigmoidectomy for diverticulitisDis Colon Rectum4163035Google Scholar
  28. 28.
    Neto, JAP, Lacombe, D 1999Video-assisted manual surgeryWexner, SD eds. Laparoscopic colorectal surgeryWiley-LissNew York30722Google Scholar
  29. 29.
    Eijsbouts, QA, Haan, J, Berends, F, Sietses, C, Cuesta, MA 2000Laparoscopic elective treatment of diverticular disease. A comparison between laparoscopic-assisted and resection-facilitated techniquesSurg Endosc148126Google Scholar
  30. 30.
    Vithianthan, S, Cooper, Z, Betten, K,  et al. 2001Hybrid laparoscopic flexure takedown and open procedure for rectal resection is associated with significantly shorter length of stay than equivalent open resectionDis Colon Rectum4492735Google Scholar
  31. 31.
    Miura, Y, Mitsuta, H, Yoshihara, T,  et al. 2001Gasless hand-assisted laparoscopic surgery for colorectal cancer: an option for poor cardiopulmonary reserveDis Colon Rectum448968Google Scholar
  32. 32.
    Jones, DB, Guo, L-W, Reinhard, MK,  et al. 1995Impact of pneumoperitoneum on trocar site implantation of colon cancer in hamster modelDis Colon Rectum3811828Google Scholar
  33. 33.
    Watson, DI, Matheus, G, Ellis, T, Balgrie, CF, Rofe, AM, Jamiesobn, G 1997Gasless laparoscopy may reduce the risk of port-site metastases following laparoscopic tumor surgeryArch Surg1321669Google Scholar
  34. 34.
    Wineberger, U, Siegl, H, Woisetschalager, R, Schrenk, P, Losert, U 1995Hemodynamic changes during prolonged laparoscopic surgeryEur Surg Res26119Google Scholar
  35. 35.
    Ballantyne, GH 1994Abdominal perineal resectionBallantyne, GHLeahy, PFModlin, IM eds. Laparoscopic surgeryWB SaundersPhiladelphia60524Google Scholar
  36. 36.
    Gant, SG 1923Inferior proctectomyGant, SG eds. Diseases of the rectum, anus, and colonWB SaundersPhiladelphia38396Google Scholar
  37. 37.
    Turner, GG 1932Conservative resection of the rectum by the lower route: the results of seventeen casesActa Chir Scand7251935Google Scholar
  38. 38.
    Thornton, S 2000Laparoscopic-assisted perineoabdominal resectionBallantyne, GH eds. Atlas of laparoscopic surgeryWB SaundersPhiladelphia47081Google Scholar
  39. 39.
    Leahy, P, Bannenberg, JJ, Meijer, DW 1994Laparoscopic colon surgery, a difficult operation made easySurg Endosc8992Google Scholar
  40. 40.
    Meijer, D, Bannenberg, J, Leahy, P, Klopper, P 1994Helping hand for laparoscopic sigmoid-resectionMinim Invasive Ther343Google Scholar
  41. 41.
    Ballantyne, GH 1994Laparoscopic-assisted sigmoid colectomy using Dexterity™. Video presentation. Surgical Grand Rounds. Georgia Baptist Hospital. AtlantaGA.April27Google Scholar
  42. 42.
    Begos, DG, Ballantyne, GH 1995Laparoscopic left hemicolectomy and anterior resectionMonson, JRDarzi, A eds. Laparoscopic colorectal surgeryIsis Medical MediaOxford1137Google Scholar
  43. 43.
    Gorey, TF, O’Riordan, MG, Tierney, S, Buckley, D, Fitzpatrick, JM 1996Laparoscopic-assisted rectopexy using a novel hand-access portJ Laparoendoscopic Surg632528Google Scholar
  44. 44.
    O’Connell, PR, Gorey, TF 1999Status of laparoscopic surgery in IrelandWexner, SD eds. Laparoscopic colorectal surgeryWiley-LissNew York45761Google Scholar
  45. 45.
    Litwin, DE, Novitsky, Y, Kercher, KW,  et al. 2000New device for hand-assisted laparoscopic surgerySurg Technol IntIX11316Google Scholar
  46. 46.
    Bemelman, WA, Ringers, J, Meijer, DW, Wit, CWM, Bannenberg, JJ 1996Laparoscopic-assisted colectomy with dexterity pneumo sleeveDis Colon Rectum39S5961Google Scholar
  47. 47.
    Memon, MA, Fitzgibbons, RJ,Jr 1998Hand-assisted laparoscopic surgery (HALS): a useful technique for complex laparoscopic abdominal proceduresJ Laparoendosc Adv Surg Tech A814350Google Scholar
  48. 48.
    Naitok, T, Gagner, M, Garcia-Ruiz, A, Heniford, BT, Matsuno, S 1999Hand-assisted laparoscopic digestive surgery provides safety and tactile sensation for malignancy or obesitySurg Endosc1315760Google Scholar
  49. 49.
    Southern Surgeons’ Club Study Group1999Handoscopic surgery: a prospective multicenter trial of a minimally invasive technique for complex abdominal surgeryArch Surg13447785Google Scholar
  50. 50.
    Scott, HJ, Darzi, A 1997Tactile feedback in laparoscopic colonic surgeryBr J Surg841005Google Scholar
  51. 51.
    Sjoerdsma, W, Meijer, DW, Jansen, A, Boer, KT, Grimbergen, CA 2000Comparison of efficiencies of three techniques for colon surgeryJ Laparoendosc Adv Surg Tech104753Google Scholar
  52. 52.
    Meijer, DW, Bannenberg, JJ, Jakimowicz, JJ 2000Hand-assisted laparoscopic surgery: an overviewSurg Endosc148915Google Scholar
  53. 53.
    Litwin, DE, Darzi, A, Jakimowicz, J,  et al. 2000Hand-assisted laparoscopic surgery (HALS) with the HandPort System: initial experience with 68 patientsAnn Surg23171521Google Scholar
  54. 54.
    Litwin, DEM, Darzi, A, Jakimowicz, J,  et al. 2000Hand-assisted laparoscopic surgery vs. standard laparoscopic surgery for colorectal disease: a prospective randomized trialSurg Endosc14896901Google Scholar
  55. 55.
    Naar, D, Alkoraishi, A, Begos, DG 2001Comparison of laparoscopic hand-assisted versus total laparoscopic colectomyJ Soc Laparoendosc Surg5380Google Scholar
  56. 56.
    Targarona, EM, Gracia, E, Garriga, J,  et al. 2002Prospective randomized trial comparing conventional laparoscopic colectomy with hand-assisted laparoscopic colectomy: applicability, immediate clinical outcome, inflammatory response and costSurg Endosc162349Google Scholar
  57. 57.
    Pietrabissa, A, Moretto, C, Carobbi, A, Boggi, U, Ghilli, M, Mosca, F 2002Hand-assisted laparoscopic low anterior resection: initial experience with a new procedureSurg Endosc164315Google Scholar
  58. 58.
    58. Espalieu Ph, Boulez J, Blanchet MC. Hand assisted laparoscopic left colectomy for sigmoiditis. In: Mouiel J, Montori, eds. E.A.E.S. Proceedings of the 8th International Congress of the European Association for Endoscopic Surgery. Bologna, Italy. Monduzzi Editore. 2000:349–54.Google Scholar
  59. 59.
    Tanaka, M, Tokuda, N, Koga, H, Yokomizo, A, Sakamoto, N, Naito, S 2000Hand assisted laparoscopic radical nephrectomy for renal carcinoma using a new abdominal wall sealing deviceJ Urol1643148Google Scholar
  60. 60.
    Tokuda, N, Nakamura, M, Tanaka, M, Naito, S 2001Hand-assisted laparoscopic live donor nephrectomy using newly produced LAP DISC: initial three casesJ Endourol165714Google Scholar

Copyright information

© The American Society of Colon and Rectal Surgeons 2004

Authors and Affiliations

  1. 1.Hackensack University Medical CenterHackensack

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