[Hand-assisted laparoscopic colectomy (HALC)]

Laparoscopic colorectal resection is not common practice, despite its proven advantages. Hand-assisted laparoscopic colectomy (HALC) combines the advantages of a format laparoscopy while minimizing its limits.

A report of our experience in hand-assisted colorectal resections.

A prospective database gathering information on 100 patients who underwent HALC in our department between the years 2007-2009.

The study group includes 60 men and 40 women. The median age is 60 years (27-88), and the median body mass index (BMI) is 25 (18-34). A total of 59% of patients were operated on due to colorectal carcinoma, 15% had a large benign polyp, and 26% colonic diverticular disease. Furthermore, 41% of patients underwent right hemicolectomy, 11% left hemicolectomy, 30% sigmoidectomy, and 18% rectal resection. The median operating time was 120 (60-220) minutes, and the average incision length was 6 +/- 0.06 cm. The conversion rate to open surgery was 5%. In the carcinoma cases, the surgical margins were free of tumor and the average lymph node number harvested was 12.3 +/- 4.3. The Learning curve stabilized after 8-12 procedures. The median time to first bowel movement was 3 days (1-8), and the median hospital stay was 5 days (3-26). Postoperative complications were observed in 19% of patients: anastomotic leak (2), ileus (2), pulmonary emboli (1), urinary retention (3), urinary tract infection (3), wound infection (7), and spontaneous pneumothorax (1). Incisional hernia was documented in 3% of patients, after an average followup of 18 +/- 4 months. One patient died due to myocardial infarction.

HALC is a safe and effective procedure that enables the preservation of the laparoscopy advantages, in a short operative time, and a rapid learning curve.