Hand-Assisted Laparoscopic Approach in Colon Surgery

Current application and prospects of hand-assisted laparoscopic surgery in gastrointestinal tumors

Hand-assisted laparoscopic surgery (HALS) refers to operations in which the surgeon inserts his/her non-dominant hand through a specific auxiliary device into the peritoneal cavity to assist the laparoscopic instruments. Because there is one hand to assist in the operation, HALS can reduce the difficulty of operation and shorten operative time. Previously, HALS is considered the transitional bridge from the traditional open surgery to laparoscopic surgery, but now, HLAS, together with total laparoscopic surgery and laparoscopic assisted surgery, is considered three forms of routine laparoscopic surgery. Along with the extensive use of laparoscopic surgery in gastrointestinal tumors, HALS, as a new method of laparoscopic surgery, has been gradually used in gastrointestinal tumors in recent years.

Clinical application of hand-assisted laparoscopy in transverse colectomy for middle transverse colon cancer

AIM: To assess the safety, feasibility and clinical application value of hand-assisted laparoscopy in transverse colectomy for middle transverse colon cancer.

METHODS: From April 2012 to April 2015, a total of 20 patients with middle transverse colon cancer underwent radical transverse colon resection at Department of Gastrointestinal Surgery of the First Affiliated Hospital of Nanchang University, of whom 11 underwent hand assisted laparoscopic surgery (HALS), and 9 underwent laparoscopic-assisted surgery (LAS). The clinical data of all the patients were retrospectively analyzed and compared between the two groups.

RESULTS: All the 20 patients had successful surgery. There was no conversion to open surgery or no operative death. Operative time was significantly shorter in the HALS group than in the LAS group (153.6 min ± 28.1 min vs 190.6 min ± 35.0 min, P = 0.017). There were no significant differences between the two groups in blood loss (121.8 mL ± 79.4 mL vs 116.1 mL ± 78.1 mL), number of lymph nodes harvested (15.4 ± 5.4 vs 17.6 ± 11.7), rate of postoperative complications (9.1% vs 11.1%), postoperative exhaust time (3.1 d ± 0.7 d vs 2.9 d ± 0.6 d), or postoperative hospital stay (7.4 d ± 0.7 d vs 7.8 d ± 1.1 d) (P > 0.05). The patients were followed for 2-38 months. In the HALS group, one patient developed intestinal obstruction at 1 mo and one patient developed liver metastases at 8 mo. In the LAS group, one patient died of extensive abdominal metastasis.

CONCLUSION: The hand-assisted laparoscopic technique is feasible and safe in the radical resection of middle transverse colon cancer. Due to a small number of patients included and short follow-up time in this study, further studies are required.