Hand-Assisted Laparoscopic Colectomy: A Helping Hand?

Adoption of laparoscopic colectomy to date has been slow because of its technical complexity and prolonged operative times. Most surgeons do not have the skill sets or colectomy volume to overcome the learning curve. The options for the future are limited. Either surgeons not skilled in laparoscopic colectomy will have to forfeit this procedure to expert laparoscopists as some have recommended or we need to find a way to simplify the procedure while maintaining the benefits of a minimally invasive approach. This article reviews the hurdles to laparoscopic colectomy and the potential benefits of the introduction of the hand to laparoscopic colectomy. In the end, the reader will have a clearer understanding of the controversy surrounding hand-assisted colectomy and why it should be expanded in its application if the majority of surgeons are to offer minimally invasive colectomy to their patients.

Laparoscopic colectomy - hand-assisted laparoscopy - hand-assisted colectomy

REFERENCES

• 1 Simons A J, Anthone G J, Ortega A E et al.. Laparoscopic-assisted colectomy learning curve.  Dis Colon Rectum. 1995;  38 600-603
• 2 Senagore A J, Luchtefeld M A, Mackeigan J M. What is the learning curve for laparoscopic colectomy?.  Am Surg. 1995;  61 681-685
• 3 Wishner J D, Baker J WJ, Hoffman G C et al.. Laparoscopic-assisted colectomy. The learning curve.  Surg Endosc. 1995;  9 1179-1183
• 4 Hyman N. How much colorectal surgery do general surgeons do?.  J Am Coll Surg. 2002;  194 37-39
• 5 Bergamaschi R, Tuetch J J, Pessaux P, Arnaud J P. Intracorporeal vs laparoscopic-assisted resection for uncomplicated diverticulitis of the sigmoid.  Surg Endosc. 2000;  14 520-523
• 6 Bergamaschi R, Tuetch J J, Cervi C, Arnaud J P. Re-establish pneumoperitoneum in laparoscopic-assisted sigmoid resection? Randomized trial.  Dis Colon Rectum. 2000;  43 771-774
• 7 Ou H. Laparoscopic-assisted mini laparotomy with colectomy.  Dis Colon Rectum. 1995;  38 324-326
• 8 O'Reilly M J, Saye W B, Mullins S G et al.. Techniques of hand-assisted laparoscopic surgery.  J Laparoendosc Surg. 1996;  6 239-244
• 9 HALS Study Group . Hand-assisted laparoscopic surgery vs standard laparoscopic surgery for colorectal disease: a prospective randomized trial.  Surg Endosc. 2000;  14 896-901
• 10 HALS Study Group . Hand-assisted laparoscopy versus standard laparoscopy for colorectal resection.  Dis Colon Rectum. 2000;  43 A20-A21
• 11 Targarona E M, Gracia E, Garriga J et al.. Prospective randomized trial comparing conventional laparoscopic colectomy with hand-assisted laparoscopic colectomy.  Surg Endoc. 2002;  16 234-239
• 12 Braveman J M, Marcello P W, Rusin L C, Roberts P L, Schoetz D J. Hand assisted laparoscopic sigmoid resection for diverticulitis: a comparison with laparoscopic resection.  Surg Endosc. 2003;  17 S234
• 13 Rivadeneira D E, Marcello P W, Roberts P L et al.. Benefits of hand-assisted laparoscopic restorative proctocolectomy: a comparative study.  Dis Colon Rectum. 2003;  46 A32