Thirteen‐year experience with hand‐assisted laparoscopic surgery in colorectal patients

Abstract

Background We report outcomes on 324 consecutive cases of hand‐assisted laparoscopic surgery (HALS) in colorectal patients over 13 years performed by a single surgeon. Methods A prospectively maintained database was used to identify all patients undergoing HALS colorectal procedures for benign or malignant indications from September 2004 to February 2018, at two major tertiary centres in Sydney, Australia. Results Median age was 64 years, 51% were female and median body mass index was 26. Colorectal cancer (55%), diverticular disease (13%) and polyp related conditions (13%) were common indications. Anterior resection (65%) and right hemicolectomy (18%) were most commonly performed. Median operative time was 244 min (190–300) and 75% of Gelport incisions were Pfannenstiel. Sixty‐three percent of colorectal cancer patients had a T3 or T4 cancer. Median tumour size was 35 mm (25–45). Seven percent required conversion to open and 4% a re‐operation in the early post‐operative period. Thirty‐six percent had a post‐operative complication, and 11% were major complications. Follow‐up extended to 12.8 years and there were 33 late deaths. Being in a high dependency unit or intensive care unit was significant for late mortality (odds ratio 2.8, 95% confidence interval 1.06–7.78, P = 0.037). Three percent developed an incisional hernia and 6% had small bowel obstruction at long‐term follow‐up. Conclusion HALS is an effective technique for both benign and malignant colorectal indications with the added advantage of tactile feedback and a lower rate of conversion to open.

Hand-assisted laparoscopic versus laparoscopic-assisted radical gastrectomy in the treatment of advanced distal gastric cancer: final results of a single-center randomized study

“…Owing to the combination of the advantages of laparoscopic surgery and open surgery, HALS has gradually developed in clinical practice. Currently, HALS is performed for gastric cancer as well as colon cancer, 9 gynecological diseases, 10 urinary system diseases, 11 and liver and spleen diseases. 12,13…”

The Role of Preoperative Platelet-to-Lymphocyte Ratio as a Predictor for Incisional Hernias after Hand-Assisted Laparoscopic Liver Surgery for Metastatic Colorectal Cancer

“…This allows for tactile feedback and assistance with retraction, dissection, and hemostasis. The same incision is then used for specimen extraction [ 4 ]. The three consensus guidelines of Southampton, Louisville, and Morioka in laparoscopic liver resections estimate that pure laparoscopic liver resection, HALS, and the hybrid technique are equivalent and just a matter of surgeon preference.…”