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Hand-assisted laparoscopic low anterior resection: initial experience with a new procedure
A Pietrabissa1, C Moretto, A Carobbi
1Divisione di Chirurgia Generale e Trapianti, Dipartimento di Oncologia, del Trapianti e delle Nuove Tecnologie in Medicina, Ospedale di Cisanello, via Paradisa 2 - 56124 Pisa, Italy. apietrabissa@med.unipi.it
Surgical Endoscopy
|April 3, 2002
Summary
Hand-assisted laparoscopic surgery (HALS) for rectal cancer offers a feasible approach, enabling pelvic dissection similar to open surgery without compromising patient recovery. This technique overcomes limitations of pure laparoscopy in treating rectal cancer.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Laparoscopic low anterior resection for rectal cancer faces challenges in pelvic dissection, limiting its adoption by general surgeons.
- Hand-assisted laparoscopic surgery (HALS) presents a potential solution to overcome technical limitations of pure laparoscopy.
- HALS may replicate the operative conditions of open surgery for rectal cancer treatment.
Purpose of the Study:
- To evaluate the technical feasibility of hand-assisted laparoscopic low anterior resection for rectal cancer.
- To assess the benefits and drawbacks of HALS in rectal cancer surgery.
- To examine early outcomes in patients undergoing HALS for extraperitoneal rectal cancer.
Main Methods:
- A pilot study involving 16 consecutive patients with extraperitoneal rectal cancer.
- Prospective examination of clinical data, operative time, conversion rates, complications, and early outcomes.
- A 12-month study period at a university hospital.
Main Results:
- Average operative time was 238 +/- 38 minutes, with no conversions to open surgery.
- Ten of 16 patients were pain medication-free by postoperative day 3; 8 ambulated on postoperative day 1.
- Three minor postoperative complications occurred, with a mean postoperative stay of 5.6 +/- 1.4 days for uncomplicated cases.
Conclusions:
- Hand-assisted laparoscopic low anterior resection facilitates pelvic dissection comparable to open surgery.
- The hand-access incision in HALS does not appear to impede the rapid recovery seen in purely laparoscopic procedures.
- HALS is a technically feasible option for rectal cancer surgery, offering comparable outcomes to open procedures with potential for faster recovery.