Experience with hand assisted laparoscopic surgery of the colon

Hand assisted laparoscopic colectomy (HALS) has been shown to have the advantages of laparoscopic colectomy in terms of pain, recovery and length of hospital stay. Studies have shown similar outcomes in laparoscopic colectomy as in open surgery. There is a learning curve to HALS, the operative time is longer, and it is more difficult than open surgery and requires specialized equipment. In this report we present our initial experience over a 2.5 year period using HALS for colon surgery for diverticulosis, polyps and colon cancer.

A retrospective review of office and hospital charts of patients undergoing HALS colectomy from June 2005 to January 2008 was performed at HIMA-San Pablo Hospital. Demographics, outcomes data including operative time, conversion rate to open surgery, reasons for conversion, time to start feedings, and length of stay were collected as well as staging and number of nodes for cancer patients. Complications are discussed along with comments pertinent to the experience of two surgeons going through the learning curves of LC and HALS colectomy.

A total of 65 patients underwent attempted hand assisted laparoscopic colon resection. There were 33 males and 32 females between the ages of 26 and 87. Thirty-one patients underwent surgery for diverticulosis; 8 for pre-malignant lesions (large polyps or polyps with high grade dysplasia), and 26 for colon cancer. Mean operative time was 195 minutes (120 to 300); mean length of stay was six days (range 4-14 days). Conversion rate was (13.8%) overall; 21% during the first year and 10.8% after the first year. 5 (7.5%) of the patients in which HALS colon resection was completed had complications with prolonged length of stay. Patients without complication had an average length of stay of 4.5 days. The average number of lymph nodes was 14.8 (range 7-24); average length of specimens for diverticulosis was 17cm. Complications included postoperative bleeding in three patients who required early reoperation, prolonged ileus and small bowel obstruction in two patients. One patient developed a pelvic collection requiring a drain, and one patient had a wound infection requiring re-admission and antibiotics. No patient required colostomy due to a complication. There were no operative deaths.

HALS colectomy is a safe and feasible alternative to open colectomy in a community hospital setting with proper expertise and equipment. Patients will benefit from faster recovery time and decreased length of stay in the hospital. Oncologic results are similar to open surgery. Operative times are longer than with open surgery and the operations are difficult to learn and master.