Hand-assisted Laparoscopic Surgery (HALS) as an Alternative to Laparoscopic Converted to Open Surgery (LCOS) in...

Hand-assisted laparoscopy is an operative approach that combines the benefits of both open and laparoscopic surgery. Despite this method, many surgeons choose to perform standard laparoscopic surgery (SLS) without the use of a hand assist. Operative challenges encountered during SLS may necessitate an unplanned laparoscopic converted to open surgery (LCOS), which may increase the risk of adverse patient outcomes. Alternatively, prior studies show that hand-assisted laparoscopic surgery (HALS) may be associated with a lower risk of postoperative morbidity. In this study, we compared preoperative factors and postoperative outcomes between HALS and LCOS in patients undergoing a proctectomy.

The 2022 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Targeted Proctectomy Database was utilized to analyze patients undergoing proctectomy procedures. From this, 211 patients who underwent an LCOS (LCOS Cohort) and 801 patients who underwent a HALS (HALS Cohort) were identified and compared.

Patients with more comorbidities were more likely to undergo an LCOS. LCOS patients experienced higher rates of postoperative complications, including blood transfusion (20.85% vs. 5.99%; P <0.001), postoperative renal insufficiency (17.06% vs. 7.12%; P <0.001), and mortality (1.90% vs. 0.37%; P =0.018). Multivariate logistic regression confirmed that undergoing an LCOS was independently associated with increased odds of postoperative renal insufficiency (OR=2.63; P <0.001) and the need for blood transfusion (OR=4.05; P <0.001).

We believe this is the first large national database study comparing HALS and LCOS approaches for proctectomies. Multivariate logistic regression confirmed that HALS was associated with better postoperative outcomes compared with LCOS. In complex cases, starting with the HALS approach may be more advantageous than the SLS method. Furthermore, hand assistance should be considered before converting to open surgery in challenging laparoscopic cases.