Hand-assisted laparoscopic surgery of abdominal large visceral organs

Table 1 (HALS) operations and indicating diseases (26 cases)

Cases	Operations	Indicating diseases
1-2	Left lateral segmentectomy	Hepatitis B-related cirrhosis supervened hepatocellular carcinoma (HCC), hepatic cavernous hemangioma
3	S 6 segmentectomy	Hepatitis B-related cirrhosis supervened HCC
4	S 5 and 6 segmentectomy	Hepatitis B-related cirrhosis supervened HCC
5	S 5, 6 and partial 4 segmentectomy + cholecystectomy	Hepatitis B-related cirrhosis supervened HCC
6	Partial S 4 segmentectomy	Hepatic cavernous hemangioma
7-11	Deroofing of the hepatic huge cysts	The 4, 6, 7, 8 segmental hepatic cysts; the 4, 5, 6, 7, 8 segmental hepatic cysts; the 5, 6, 7 segmental hepatic cysts (2); the 5, 6, 7 segmental hepatic cysts with calcification of cystic wall
12-15	Right hemicolectomy	Carcinoma of the ascending colon (3) 1Multiple diverticulosis of ascending colon with massive hemorrhage
16	Left hemicolectomy + partial jejunectomy	Carcinoma of the splenic flexure of colon with metastasizing to liver and jejunum,
17	Left hemicolectomy	2Carcinoma of the sigmoid with metastasizing to left ureter and common iliac artery
18-19	Ileocecectomy	1Carcinoma of the terminal ileum with ileus, multiple diverticulosis of the ileocecum and chronic appendicitis
20-21	Splenectomy	Idiopathic thrombocytopenic purpura, carcinoma of pancreatic body and tail
22-25	Subtotal gastrectomy	Duodenal ulcer (2), gastric ulcer, gastric ulcer with massive hemorrhage
26	Half gastrectomy + cholecystectomy	Diverticulitis of duodenum and gall stone

¹ Emergency operation;

²Conversion to open operation.

Table 2 Location of the ports and positioning of the operator

Operations	HandPort	Camera1	Scalpel1	Operator2
Left hepatic lateral segmentectomy	R upper transrectus3	Umbilicus	L upper quadrant	R
Right hepatic segmentectomy	R pararectus abdominis	Umbilicus	L upper quadrant	R
Deroofing of the hepatic huge cyst	R subcosta	Umbilicus	L upper quadrant	L
	R upper transrectus	Umbilicus	L upper quadrant	L
	R pararectus abdominis	Umbilicus	L upper quadrant	R
Splenectomy	Upper midline4	Umbilicus	L umbilicus level	R
	L upper transrectus	Umbilicus	L lower umbilicus level	R
Right hemicolectomy	Upper midline	Umbilicus	Lower midline	R
Left hemicolectomy + partial jejunectomy	Upper midline	Umbilicus	Lower midline	R
Subtotal gastrectomy	Upper midline	Umbilicus	L lower umbilicus level	R
Half gastrectomy +cholecystectomy	Upper midline	Umbilicus	R lower umbilicus level	R
Ileocecectomy	Lower midline3	Umbilicus	R middle quadrant	L

¹Camera and Scalpel can change places with each other during operation;

²Left hand into abdomen, operator can change places during operation;

³Two incisions for HandPort device were at the previous wounds of right upper transrectus abdominis and lower midline involved open partial gastrectomy and caesarean operation.respectively;

⁴Just under the xiphoid process; R: right, L: left.

Table 3 Indications for conventional surgery (25 cases)

Cases	Operations	Indications
1-2	Left lateral segmentectomy	Hepatitis B-related cirrhosis supervened HCC, hepatic cavernous hemangioma
3-6	Deroofing of the hepatic huge cysts	Right hepatic huge cysts (4)
7-8	Hepatic S 5 and 6 segmentectomy	Hepatic cavernous hemangioma, hepatitis B-related cirrhosis supervened HCC
9-10	Hepatic S 6 segmentectomy	Hepatitis B-related cirrhosis supervened HCC, hepatic cavernous hemangioma
11	Hepatic S 5 segmentectomy + cholecystectomy	Hepatitis B-related cirrhosis supervened HCC
12-13	Splenectomy	Splenic infarction, splenic cysts
14-17	Right hemicolectomy	Carcinoma of the ascending colon (3), multiple polyps of ascending colon
18	Left hemicolectomy	Carcinoma of the descending colon
19-20	Ileocecectomy	Carcinoma of the terminal ileum, multiple diverticulosis
21-25	Subtotal gastrectomy	Duodenal ulcer(2), 1gastric ulcer with bleeding, gastric ulcer, diverticulitis of duodenum with bleeding

¹Emergency operation.

Table 4 HALS compared with conventional open surgery

	Cases	Incision(cm)	Time ofoperation(min)	Operativebleeding(mL)	Postoperativefeeding (d)	Hospitalstay (d)
Open surgery	25	16-33	125-240	80-900	2-6	7-26
(mean)		22.5	190	340	4	13
HALS	251	5-6	30-120	8-120	1-3	4-15
(mean)		5.3	86	85	1.8	7

¹One of the 26 patients converting to open operation was not included.Statistical comparison was performed using the Independent-Samples t-Test (P < 0.001).