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Hand-assisted or laparoscopic-assisted approach in colorectal surgery: a systematic review and meta-analysis
A G J Aalbers1, S S A Y Biere, M I van Berge Henegouwen
1Department of Surgery, Academic Medical Center, Location G4-129, Postbox 22660, 1100 DD, Amsterdam, The Netherlands.
Insights
Hand-assisted laparoscopic surgery (HALS) is more efficient for segmental colectomies than laparoscopic-assisted colectomies (LAC), reducing operating time and conversion rates. HALS also offers operating time benefits for total colectomies, making it a valuable laparoscopic tool.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Surgical Techniques
Background:
- Laparoscopic and laparoscopic-assisted colectomies (LAC) offer benefits but have technical challenges.
- Hand-assisted laparoscopic surgery (HALS) was developed to ease the transition to minimally invasive procedures.
- A direct comparison of HALS versus LAC in colorectal surgery is needed.
Purpose of the Study:
- To systematically review and compare Hand-assisted laparoscopic surgery (HALS) with Laparoscopic-assisted colectomies (LAC) in colorectal resections.
- To evaluate operating time, conversion rates, hospital stay, and morbidity between HALS and LAC.
Main Methods:
- Systematic review of electronic databases (Medline, Embase, Cochrane) and cross-reference searches.
- Inclusion of 13 studies (2 RCTs, 11 non-RCTs) with 1017 patients.
- Data extraction and quality assessment performed by two independent reviewers.
Main Results:
- For segmental colectomies, HALS showed significant advantages in operating time (19 min) and conversion rate (OR 0.3).
- For total (procto)colectomies, HALS demonstrated a significant operating time advantage (61 min).
- No significant differences were reported for hospital stay or morbidity in the review.
Conclusions:
- HALS is more efficient for segmental colectomies, particularly for diverticulitis, in terms of operating time and conversion rates.
- HALS offers a significant operating time advantage for total (procto)colectomies.
- HALS is a valuable addition to laparoscopic surgery, aiding in avoiding conversions and expediting complex colectomies.
Background:
Evidence of benefits of laparoscopic and laparoscopic-assisted colectomies (LAC) over open procedures in gastrointestinal surgery has continued to accumulate. With its wide implementation, technical difficulties and limitations of LAC have become clear. Hand-assisted laparoscopic surgery (HALS) was introduced in an attempt to facilitate the transition from open techniques to minimally invasive procedures. Continuing debate exists about which approach is to be preferred, HALS or LAC. Several studies have compared these two techniques in colorectal surgery, but no single study provided evidence which procedure is superior. Therefore, a systematic review was carried out comparing HALS with LAC colorectal resection.
Methods:
Eligible studies were identified from electronic databases (Medline, Embase Cochrane) and cross-reference search. The database search, quality assessment, and data extraction were independently performed by two reviewers. Minimal outcome criteria for inclusion were operating time, conversion rate, hospital stay, and morbidity.
Results:
Out of 468 studies a total of 13 studies were selected for comprehensive review. Two randomized controlled trials (RCT) and 11 non-RCTs, comprising 1017 patients, met the inclusion criteria. Because of possible clinical heterogeneity two groups of procedures were created: segmental colectomies and total (procto)colectomies. In the segmental colectomy group significant differences in favor of the HALS group were seen in operating time (WMD 19 min) and conversion rate (OR of 0.3 conversions). In the total (procto)colectomy group a significant difference in favor of the HALS group was seen in operating time (WMD 61 min).
Conclusions:
This systematic review indicates that HALS provides a more efficient segmental colectomy regarding operating time and conversion rate, particularly accounting for diverticulitis. A significant operating time advantage exists for HALS total (procto)colectomy. HALS must therefore be considered a valuable addition to the laparoscopic armamentarium to avoid conversion and speed up complicated colectomies.
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