A comparison of laparoscopic, hand-assist and open sigmoid resection in the treatment of diverticular disease

Advantages of the hand-assisted versus the open approach to elective colectomies

“…The operative time for this series was significantly longer for the HALC group than for the OC group. This is consistent with the literature, in which the median operative times differ 13 to 81 min [16][17][18][19]. Although longer operative times did not seem to result in any clinically significant adverse effects, the open approach may be preferred when shorter anesthesia time is of the highest priority.…”

“…These findings are consistent with a review series by Aalbers et al [20] with reported postoperative morbidity rates ranging from 5% to 20% for HALC patients and 17% to 30% for OC patients. With the exception to the study of Anderson et al [16], no previous study comparing HALC and OC has found a significant difference in mortality. Interestingly, the patients in our OC group had a significant increase in the number of cardiopulmonary events versus the HALC group (Table 3).…”

“…Findings have shown that minimally invasive approaches to colon resections are associated with longer operative times [9,16]. This likely is due to the additional time spent obtaining pneumoperitoneum, abdominal access, and placement of the hand port.…”

“…The addition of tactile feedback to standard laparoscopy has the potential to enhance the surgeon's manipulation of tissues, promote safe blunt dissection, and enable atraumatic retraction [12]. Although the benefits of hand-assisted colectomies have been compared with those of ''pure'' laparoscopic techniques by many investigators [13][14][15][16], the analysis comparing HALC and OC has been insufficient to date. Many opponents of HALC have suggested that the need for a hand-port incision eliminates the benefit of minimal access.…”

A Three-Arm (Laparoscopic, Hand-Assisted, and Robotic) Matched-Case Analysis of Intraoperative and Postoperative Outcomes in Minimally Invasive Colorectal Surgery

“…1,4,9,20 Although one might anticipate that a new technique such as RALS may initially result in higher complication rates compared with those of established modalities such as CLS and HALS, this was not our experience. In fact, RALS resulted in a comparably low complication rate compared with CLS and HALS, thus indicating the safety of this emerging approach.…”