Ann Coloproctol.  2017 Aug;33(4):125-129. 10.3393/ac.2017.33.4.125.

Hand-Assisted Laparoscopic Surgery: A Versatile Tool for Colorectal Surgeons

• Cheong JY
• Young CJ

• KMID: 2391453
• DOI: http://doi.org/10.3393/ac.2017.33.4.125

Abstract

PURPOSE
Hand-assisted laparoscopic surgery (HALS) is a minimally invasive surgical technique with the combined benefits of laparoscopic surgery while allowing the use of the surgeon's hand for better tactile control. Obesity has been associated with higher conversion rates with multiport laparoscopic surgery, but not with HALS. This study aimed to examine the versatility of HALS in various clinical contexts.
METHODS
All HALSs performed at 2 major tertiary centers in Sydney were prospectively collected for retrospective analysis. Variables including age, sex, body mass index (BMI), previous surgeries, pathologies including size and T-stage, and the number of conversions to a midline laparotomy were examined.
RESULTS
A total of 121 HALS colorectal resections were analyzed. The median age of the patients was 62 years, with 63.6% being women. Seven patients required conversion to a midline laparotomy. Of the 121 patients, 50.2% were overweight or obese, and 52.9% had undergone previous abdominal/pelvic operations. However, neither obesity nor abdominal adhesions from previous operations were an indication for conversion to an open laparotomy in any of the 7 converted patients. The presence of intra-abdominal adhesions did not impact the operative time. HALS allowed access to the entire colon and rectum and allowed resection of the bladder, uterus, and ureter, when these organs were involved.
CONCLUSION
HALS is a versatile, minimally invasive technique, which is independent of the patient's BMI, for performing a colorectal resection.

Keyword

Hand-assisted laparoscopy; Colorectal surgery

MeSH Terms

Body Mass Index
Colon
Colorectal Surgery
Female
Hand
Hand-Assisted Laparoscopy*
Humans
Laparoscopy
Laparotomy
Obesity
Operative Time
Overweight
Pathology
Prospective Studies
Rectum
Retrospective Studies
Surgeons*
Ureter
Urinary Bladder
Uterus