Controversy of hand-assisted laparoscopic colorectal surgery

Table 1 Published studies comparing hand-assisted laparoscopic colorectal surgery with open colorectal surgery

Study, yr	Patients (HALC vs open)	Indication	Procedure	OT (min)	Blood loss (mL)	Analgesia narcotics or POD	Diet (POD)	Complications	LOS (d)
Maartense et al[17], 2004	30 vs 30	UC and FAP	RPIPAA	214 vs 133	262 vs 300	30 mg vs 31 mg	6 vs 7	20% vs 17%	10 vs 11
Chung et al[16], 2007	41 vs 40	Cancer	R. colectomy	110 vs 97	35 vs 50	19 mg vs 54 mg	3 vs 3	9.7% vs 22.5%	7 vs 9
Kang et al[18], 2004	30 vs 30	Benign and malignant CR diseases	Colectomies (R, L and total), AP	169 vs 172	193 vs 84	2.6 d vs 3.3 d	3.7 vs 4.4	13% vs 30%	8 vs 10

UC: Ulcerative colitis; FAP: Familial adenomatous polyposis; RPIPAA: Restorative proctocolectomy and ileal pouch-anal anastomosis; OT: Operative time; POD: Postoperative day; HALC: Hand-assisted laparoscopic colectomy; R: Right; L: Left; AP: Anterior resection; CR: Colorectal.

Table 2 Published studies comparing hand-assisted laparoscopic colorectal surgery with laparoscopically assisted colorectal surgery

Study, yr	Patients (HALC vs LAC)	OT (min)	Incision length (cm)	Complications (%)	Conversion rate (%)	LOS (d)	Bowel function (d)	Comments and conclusion
HALS study[14], 2000	18 vs 22	142 vs 151	7.4 vs 7.0	4.5 vs 5.5	14 vs 22	7 vs 6	NA	HALC retains the benefits of MIS
Targarona et al[20], 2002	27 vs 27	120 vs 135	NA	26 vs 22	7 vs 23	POD3: 6 vs 6	NA	Inflammatory markers such as interleukin-6 and C-reactive proteins were raised in HALC group
MITT study[21], 2008	47 vs 48	163 vs 210	8.2 vs 6.1	19 vs 21	2 vs 12.5	5 vs 4	2.5 vs 3	The OT can be reduced by > 30 min and 60 min in SC and TC; respectively if conducted by HALC
Polle et al[22], 2008	30 vs 35	214 vs 298	NA	Major: 16.5 vs 20	NA	10 vs 9	6 vs 5	No significant short-term benefits for total laparoscopic compared with HALRPC with respect to morbidity, OT, QOL, costs, and LOS
Tjandra et al[23], 2008	32 vs 31	170 vs 188	NA	22 vs 25.8	0 vs 0	5.9 vs 5.8	3.4 vs 1.9	Some difference in recovery in favour of the laparoscopic group
Hassan et al[24], 2008	109 vs 149	276 vs 211	NA	18 vs 11	15 vs 11	6 vs 5	3 vs 3	HALS facilitates expansion of a MIS colectomy to include challenging procedures while maintaining short-term benefits of LAC
Chang et al[25], 2005	66 vs 85	189 vs 203	8.1 vs 6.2	21 vs 23	0 vs 13	5.2 vs 5	2.5 vs 2.8	No difference in return of bowel function, LOS or complications. Significant difference in the OT and conversion rate in favour of HALC group. The incision size was smaller in the LAC group
Ringley et al[10], 2007	22 vs 18	120 vs 156	7 vs 5.5	Similar	NA	4 vs 4	NA	HALC is associated with shorter OT and greater lymph node harvest, but equal I.O blood loss, pedicle length and LOS

HALC: Hand-assisted laparoscopic colectomy; LAC: Laparoscopically assisted colectomy; OT: Operative time; LOS: Length of hospital stay; NA: Not available; MIS: Minimally invasive surgery; HALRPC: Hand-assisted laparoscopic restorative proctocolectomy; QOL: Quality of life; POD3: Postoperative day 3.