Abstract
Introduction
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.
Methods
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.
Results
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)].
Conclusions
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hand-assisted laparoscopic surgery vs. standard laparoscopic surgery for colorectal disease: a prospective randomized trial. (2000) HALS study group. Surg Endosc 14(10):896–901
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 670–672
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):291–307
Lee SW, Yoo J, Dujovny N, et al. (2006) Laparoscopic vs. hand-assisted laparoscopic sigmoidectomy for diverticulitis. Dis Colon Rectum 49(4):464–469
Meijer DW, Bannenberg JJ, Jakimowicz JJ (2000) Hand-assisted laparoscopic surgery: an overview. Surg Endosc 14(10):891–895
Kurian MS, Patterson E, Andrei VE, et al. (2001) Hand-assisted laparoscopic surgery: an emerging technique. Surg Endosc 15(11):1277–1281
Ballantyne GH, Leahy PF (2004) Hand-assisted laparoscopic colectomy: evolution to a clinically useful technique. Dis Colon Rectum 47(5):753–765
Darzi A (2000) Hand-assisted laparoscopic colorectal surgery. Surg Endosc 14(11):999–1004
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):715–723
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):397–401
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):1077–1082
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): 234–237
Nakajima K, Lee SW, Cocilovo C, et al. (2004) Hand-assisted laparoscopic colorectal surgery using GelPort. Surg Endosc 18(1):102–105
Kang JC, Chung MH, Chao PC, et al. (2004) Hand-assisted laparoscopic colectomy vs open colectomy: a prospective randomized study. Surg Endosc 18(4):577–581
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 991–992
Chang YJ, Marcello PW, Rusin LC, et al. (2005) Hand-assisted laparoscopic sigmoid colectomy: helping hand or hindrance? Surg Endosc 19(5):656–661
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):975–981
Nakajima K, Lee SW, Cocilovo C, et al. (2004) Laparoscopic total colectomy: hand-assisted vs standard technique. Surg Endosc 18(4):582–586
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):1845–1850
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 1336–1337
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hassan, I., You, Y.N., Cima, R.R. et al. Hand-assisted versus laparoscopic-assisted colorectal surgery: Practice patterns and clinical outcomes in a minimally-invasive colorectal practice. Surg Endosc 22, 739–743 (2008). https://doi.org/10.1007/s00464-007-9477-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9477-4