Hand-assisted laparoscopic low anterior resection for rectal carcinoma

Laparoscopic low anterior resection for rectal carcinoma has never been widely accepted among general surgeons because of the technical difficulties encountered during pelvic dissection. We describe our technique of hand-assisted laparoscopic low anterior resection (HAL-LAR) for rectal carcinoma using the Lapdisc abdominal wall sealing device (Hakko Medical, Tokyo, Japan, and Ethicon Endo- Surgery, New Brunswick, New Jersey) which results in pelvic dissection almost equivalent to the laparotomic operation. Thirteen patients with rectal adenocarcinoma (lower edge less than 15 cm from the anal verge) underwent laparoscopic low anterior resection, including 8 standard laparoscopic low anterior resections (SL-LAR) and 5 HAL-LAR. The mean operative time in the HAL-LAR group (211 +/- 48 min) was significantly shorter than in the SL-LAR group (311 +/- 78 min) (P = 0.0268). The mean intraoperative blood loss in the HAL-LAR group (37 +/- 45 g) was less than that in the SL-LAR group (198 +/- 177 g) (P = 0.075). The mean distal margin in the HAL-LAR group (23 +/- 4.5 mm) was longer than in the SL-LAR group (15 +/- 13.1 mm) (P = 0.2199). One patient in the SL-LAR group was found to have anastomotic recurrence in the staple suture line 10 months after surgery and died from cancer 24 months after surgery. One patient in the SL-LAR group was converted to open surgery because the distal margin was insufficient. In the HAL-LAR group, there were no intra- or postoperative complications, no conversion to open surgery, and no recurrence after surgery.