Laparoscopic Colorectal Surgery for Obese Patients: Decreased Conversions with the Hand-Assisted Technique

Abstract

In obese patients who require colectomy, the HALS approach increases the likelihood of a successful minimally invasive operation. At the cost of a clinically negligible increase in incision length, HALS may save a high-risk group conversion to formal laparotomy and the adverse outcomes related to this.

Intracorporeal versus Extracorporeal Anastomoses Following Laparoscopic Right Colectomy in Obese Patients: A Case-Matched Study

“…In this study, patients in the EA group experienced a conversion rate of 17.1%, which is in range with the reported rates of others dealing with obese patients [17][18][19]. A conversion rate of 12.5% for EA following LPS right colectomy, in fact, was recently reported by the Cleveland Clinic Group in a large series including 496 obese patients undergoing totally LPS or hand-assisted colorectal resection [18]. Moreover, figures ranging between 7.9 and 39% have been reported in a meta-analysis by Makino et al [19] including 1,766 obese patients undergoing different colorectal LPS procedure.…”

“…Similar [5,12] increased [13] or reduced [14][15][16][17] conversion rates for IA have been reported so far. In this study, patients in the EA group experienced a conversion rate of 17.1%, which is in range with the reported rates of others dealing with obese patients [17][18][19]. A conversion rate of 12.5% for EA following LPS right colectomy, in fact, was recently reported by the Cleveland Clinic Group in a large series including 496 obese patients undergoing totally LPS or hand-assisted colorectal resection [18].…”

“…Moreover, Chaves et al [15] reported a lower number of lymph nodes harvested when the vascular ligation was performed extracorporeally in a case-control study comparing IA vs. EA following LPS right colectomy. Therefore, many authors now adopted the technique of intracorporeal high-vessel ligation combined with an EA [12,14,18,23]. The similar results obtained in both groups in terms of clearance from the tumor and number of lymph-node harvested seems to support the absence of differences in extent of dissection.…”

Hand-assisted laparoscopic surgery compared with open resection for mid and low rectal cancer: a case-matched study with long-term follow-up

“…Whereas, in a study carried out in Cleveland Clinic in obese patients (BMI > 30), HALS resulted in lower conversion rate compared with LAP (3.5 vs. 12.7 %). Therefore, Heneghan et al suggested HALS as a first-line approach for colorectal surgery in obese patients [9]. It also indicated that conversion from LAP to HALS in difficult or complicated cases should be considered to reduce conversion rate to open surgery.…”

“…Whereas hand-assisted laparoscopic surgery (HALS), a hybrid endoscopic technique incorporating elements of both laparoscopic and open techniques, can overcome these existing limitations. Since the first report in 1995 [8], HALS has been demonstrated more efficient than standard laparoscopic surgery as far as operating time and conversion rate were concerned [9–13], with oncological clearance comparable to open colorectal resection [14, 15]. However, to date, little solid evidence exists in support of HALS for mid and low rectal cancer in terms of locoregional recurrence and long-term survival outcomes.…”