Hand-assisted laparoscopic colorectal surgery (HALS) at a community hospital - A prospective analysis of 104 consecutive cases

Background: We report 104 consecutive cases of hand-assisted laparoscopic (HAL) colectomy over 5 years performed by a single surgeon. Methods: Data were gathered prospectively and include patient demographic data, diagnosis, operating time, conversion rate, length of hospital stay, and complications. Virtually all patients presenting for elective resection with benign disease and metastatic cancer were treated using HAL techniques. Results: The mean age was 61 years; 48% of patients had diverticulitis; 21%, colorectal cancer; 18%, benign polyps. In addition, 55% of patients underwent sigmoid or left colectomy; 27%; right hemicolectomy; 9%, low anterior resection, and two double resections were performed. Mean operating room time was 135 minutes; in 12% of the patients conversion to open surgery became necessary, in most cases requiring only a small extension of the HAL incision. Mean and median discharge was postoperative day 4 and postoperative day 3, respectively. There was 1 death (1%) and 21% of patients had complications, 12% of them major. Conclusions: Hand-assisted laparotomy colectomy is a safe and effective procedure. The data in terms of length of hospital stay and operative time compare favorably with published data for conventional laparoscopic (CL) colectomy. Although further study is necessary, it appears that HALS confers all of the advantages of CL for colectomy, with no obvious drawbacks.