Comparison of Short-term Outcomes of Hand-assisted Laparoscopic,Laparoscopic-assisted and Open Colorectal Cancer Surgery / 中国医科大学学报

Objective To compare the short-term clinical outcomes of hand-assisted laparoscopic surgery(HALS),laparoscopic-assisted surgery (LAS)and open surgery(OS)for colorectal cancer treatment. Methods The clinical data of 74 patients underwent HALS,LAS and OS for colorectal cancer treatment between October 2011 and December 2015 were assessed retrospectively. All the surgeries were performed by the same surgical team. The intraoperative details,postoperative recovery,postoperative complications,oncologic results and cost were compared among the three groups. Results A total of 24 patients in HALS group,25 patients in LAS group and 25 patients in OS group were finally included. The gen-eral data and oncologic baseline were comparable among the three groups. The comparative results showed that the operative time increase d and in-cision length shortened gradually in OS group,HALS group and LAS group(P0.05). In terms of post-operative recovery,postoperative complications and oncologic results,there was no statistical difference between the three groups(P>0.05). As for cost,the total cost and operative cost of OS group were lower than HALS group and LAS group(P0.05). The material cost increase gradually in OS group ,HALS group and LAS group(P0.05). Conclusion HALS,LAS and OS are compen-satory with each other,and clinicians can choose the reasonable procedure according to personal proficiency and situation of patients.

Comparative study of hand-assisted laparoscopy and laparoscopy-assisted radical operation for colorectal cancer / 西安交通大学学报(医学版)

ABSTRACT:Objective To compare the short-term efficacy of hand-assisted laparoscopic surgery and laparoscopy-assisted radical operation,and evaluate the safety of hand-assisted laparoscopic surgery and its effect on systemic stress inflammation in colorectal cancer.Methods Totally 100 patients who had colorectal cancer and underwent radical operation from September 2012 to March 2016 were selected and divided into hand-assisted laparoscopy group (Group A,n=6 3 )and laparoscopy-assisted group (Group B,n=3 7 )according to the random number table.We compared operation index,postoperative complications and systemic inflammatory response levels in the two groups.Results Group B outperformed Group A in operation time,bleeding volume and drainage volume (P0 .0 5 ).Systemic inflammatory reaction index of neutral granulocyte number and C reactive protein (CRP)showed no significant differences between the two groups (P>0 .0 5 ),but inflammatory cytokine IL-6 level in Group B was significantly higher than the that in Group A (P<0.05).Conclusion Hand-assisted laparoscopic surgery has shorter operation time,lower bleeding volume than laparoscopy-assisted operation in the treatment of colorectal cancer,but the latter one has more advantages in postoperative gastrointestinal function recovery.The inflammatory cytokine IL-6 level in hand-assisted laparoscopic surgery is higher than that in laparoscopy,suggesting that the choice of operation methods should be based on the actual situation in clinical application.

Laparoscopic surgery for left-sided colon cancer: Clinical and long-term oncologic outcomes

PURPOSE: Laparoscopic surgery for left-sided colon cancer is one of the most frequent procedures performed in laparoscopic colorectal surgery. In this study, we analyzed clinical and long-term oncological outcomes of left-sided colon cancer patients who underwent conventional laparoscopic surgery (CLS) and hand-assisted laparoscopic surgery (HALS).METHODS: A total of 172 CLS patients and 72 HALS patients for left-sided colon cancer from July 2001 to December 2011 were included in this study. The collected data included the clinical and oncological outcomes. We analyzed overall survival and disease-free survival by tumor, node, metastasis (TNM) stage.RESULTS: The mean age of the patients was 64 years, and male patients were predominant. The mean follow-up period was 58.1 months. The number of patients that belong in each TNM stage 0, I, II, III, and IV was as follows: 17 (7%), 47 (19.2%), 70 (28.7%), 80 (32.8%), and 30 (12.3%), respectively. Overall 5-year survival rate for TNM stage I, II, III, and IV was 87.1%, 82.8%, 82%, and 12%, respectively. Overall 5-year survival rate for CLS group and HALS group was 90.2% and 66.7%, 86.5% and 77%, 88.7% and 67.4%, and 18.9% and 0%, respectively. Disease-free 5-year survival rate for TNM stage I, II, and III was 97.7%, 90.7%, and 72.8%, respectively. Disease-free 5-year survival rate for CLS group and HALS group was 97.3% and 100%, 100% and 78.8%, and 81% and 55.1%, respectively.CONCLUSION: These data show the feasibility and safety of laparoscopic surgery for left-sided colon cancer in terms of long-term oncological outcomes.

Feasibility of Hand-Assisted Laparoscopic Surgery as Compared to Open Surgery for Sigmoid Colon Cancer: A Case-Controlled Study

PURPOSE: The aim of this study was to evaluate short-term clinical outcomes by comparing hand-assisted laparoscopic surgery (HALS) with open surgery for sigmoid colon cancer. METHODS: Twenty-six patients who underwent a hand-assisted laparoscopic anterior resection (HAL-AR group) and 52 patients who underwent a conventional open anterior resection during the same period were enrolled (open group) in this study with a case-controlled design. RESULTS: Pathologic parameters were similar between the two groups. The incidences of immediate postoperative leukocytosis were 38.5% in the HAL-AR group and 69.2% in the open group (P = 0.009). There were no significant differences between the two groups as to leukocyte count, hemoglobin, and hematocrits (P = 0.758, P = 0.383, and P = 0.285, respectively). Of the postoperative recovery indicators, first flatus, sips of water and soft diet started on postoperative days 3, 5, 7 in the HALS group and on days 4, 5, 6 in the open group showed statistical significance (P = 0.021, P = 0.259, and P = 0.174, respectively). Administration of additional pain killers was needed for 1.2 days in the HAL-AR group and 2.4 days in the open group (P = 0.002). No significant differences in the durations of hospital stay and the rates of postoperative complications were noted, and no postoperative mortality was encountered in either group. CONCLUSION: The patients with sigmoid colon cancer who underwent a HAL-AR had a lower incidence of postoperative leukocytosis, less administration of pain killers, and faster first flatus than those who underwent open surgery. Clinical outcomes for patients' recovery and pathology status were similar between the two groups. Therefore, a HAL-AR for sigmoid colon cancer is feasible and has the same benefit as minimally invasive surgery.

Comparison of Short-term Follow-up Results of Open, Laparoscopic and Hand-assisted Laparoscopic Colectomy in Colorectal Cancer / 이화의대지

OBJECTIVES: Hand-assisted laparoscopic surgery had both technical advantages of open surgery and better postoperative short-term follow-up results of laparoscopic surgery. We compared open colectomy, laparoscopic colectomy and hand-assisted laparoscopic colectomy, and tried to find the most effective operative modality. METHODS: 90 patients, who were diagnosed with colorectal cancer and underwent colectomy in our institution, were categorized as 3 groups of open colectomy (OC) group, laparoscopic colectomy (LC) group and hand-assisted laparoscopic colectomy (HALC) group by the surgical modality. RESULTS: In this study, ratio of male and female was 57 : 37, and mean age was 64.1 years old. LC group and HALC group showed longer operation time, shorter hospital stay after operation, lesser pain and earlier removal of closed drainage catheter than OC group. Amount of bleeding during operation, frequency of transfusion and incidence of complication showed no significant difference. In permanent pathologic results, the number of harvested lymph nodes had significant difference between OC group and other groups (P=0.030), but it was probably caused by the bias of the different distribution of the stages in each group. Overall 14 of the cases resulted in complications while there was no mortality. CONCLUSION: Laparoscopic colectomy and hand-assisted laparoscopic colectomy showed better short-term follow-up results rather than open colectomy. And hand-assisted laparoscopic surgery could provide tactile sensation to operator, which lacked in laparoscopic surgery. Hand-assisted laparoscopic colectomy could be an alternative surgical option for colorectal cancer with these advantages.

A Comparison of Standard Laparoscopic Surgery and Hand-Assisted Laparoscopic Surgery in Patients with Diverticular Diseases of the Large and the Small Bowel

PURPOSE: In complicated diverticular disease, hand-assisted laparoscopic surgery (HALS) has been considered as a useful alternative treatment to standard laparoscopic surgery (SLS) and open surgery. As compared with standard laparoscopic surgery, HALS offers advantages such as tactile sense, better exposure, and shorter learning curve. Minimally invasive surgery is another advantage of HALS. The aim of this study was to compare SLS to HALS in patients with diverticular diseases of the small bowel and the colon. METHODS: We retrospectively reviewed the records of 32 patients who had undergone SLS and HALS for diverticular disease between February 2002 and March 2009. RESULTS: Of the 32 patients, 20 patients (62.5%) were in the SLS group, and 12 patients (37.5%) were in the HALS group. The mean maximal incision length was longer in the HALS group (SLS group vs. HALS group, 4.5 vs. 7.4 cm, P<0.001). However, the mean operating time, the time to flatus, the time to diet, the mean duration of narcotic analgesia, the length of hospital stay, and the postoperative complications were similar. There was no mortality in either group. CONCLUSION: The longest incision length for the HALS group was longer than that for the SLS group, but HALS could reduce the conversion rate and has the many advantages of minimally invasive surgery. For complicated diverticular disease, HALS may be considered as a useful alternative treatment.

Learning Curve for Laparoscopic Colorectal Surgery: Hand Assisted Laparoscopic Surgery (HALS) versus Conventional Laparoscopic Surgery (CLS)

Purpose: Laparoscopic colorectal surgery is technically demanding and needs a longer learning curve than open surgery. HALS (hand-assisted laparoscopic surgery) is a useful alternative to conventional laparoscopic surgery (CLS) because of its palpability and hand dissection. We compared the learning curves between HALS and CLS for colorectal surgery. Methods: A prospective study without randomization was conducted with the participation of two colorectal surgeons who had not experienced a laparoscopic colorectal operation. The collected data included operative features, oncologic outcomes, and early clinical outcomes. Fifty patients were enrolled in each group, the HALS group and the CLS group. Results: None of the operations converted to open surgery. The operative time was significantly shorter in the HALS group than in the CLS group (149.6+/-34.6 minutes versus 179.1+/-36.5 minutes, P<0.001). On a subgroup analysis of the operative time in the anterior resection, the operative time was consistent after the 13th operation in HALS group. However, in CLS group, there was a continuous fluctuation of the operative time until 25 cases. In regard to the oncologic outcome, the numbers of total harvested lymph nodes and the proximal and the distal margins in the anterior resection showed no statistical differences (P=0.400, P=0.908, and P=0.073, respectively). The early clinical results were similar in both groups. Conclusions: In the learning curve study, the HALS group had a shorter operative time and reached a learning curve plateau earlier than the CLS group. Other parameters, such as the oncologic results and the early postoperative clinical outcomes, showed no differences between the two groups.

Hand-assisted laparoscopic radical resection for colorectal cancer using the LapDisc / 中国微创外科杂志

Objective To investigate clinical effects of hand-assisted laparoscopic radical resection for colorectal cancers. Methods A series of 27 cases of colorectal cancer received hand-assisted laparoscopic radical surgery using the LapDisc. Results All the operations were successfully accomplished without conversions to open surgery. The operation time was 90~260 min (mean, 140 min), and the intraoperative blood loss was 50~200 ml (mean, 110 ml). No deaths or anastomotic leakages were observed after surgery. Follow-up for 6~23 months (mean, 8.6 months) found no port-site metastasis. Conclusions Hand-assisted laparoscopic radical resection for colorectal cancers gives advantages of safety, minimal invasion, quick recovery, and simplicity of performance.

Hand-assisted laparoscopic resection for liver hemangioma using the LapDisc / 中国微创外科杂志

Objective To evaluate the feasibility and techniques of hand-assisted laparoscopic resection using the LapDisc in patients with hepatic hemangioma. Methods A total of 8 patients with hepatic hemangioma underwent hand-assisted laparoscopic partial hepatectomy. The patients consisted of 6 men and 2 women, with the age ranging 30~72 years (mean, 47.6 years). Results The hand-assisted laparoscopic hepatectomy was successfully performed in all the patients. The average operating time was 196.3 min (range, 110～350 min), the average blood loss was 307.5 ml (range,100～750 ml), and the average postoperative hospital stay, 7.9 days (range,6～15 days). No postoperative complications such as bile leakage, intraabdominal bleeding or infection occurred. Conclusions Hand-assisted laparoscopic hepatectomy using the LapDisc is safe and feasible for patients with hepatic hemangioma with surgical indications.

Laparoscopy-assisted Billroth I Gastrectomy Compared with Hand-assisted Laparoscopic Surgery for Early Gastric Cancer -A Prospective Study-

PURPOSE: To compare standard laparoscopy-assisted Billroth I gastrectomies including standard lymph node dissection (LABIG) with hand-assisted laparoscopic surgery with the HandPort system (HALS) for the removal of early gastric cancers (EGC). METHODS: A prospective study was performed on 26 patients of EGC at Ewha Womans University Mok-Dong Hospital from July 1999 to August 2001. Seventeen patients (Group L) received LABIG using conventional laparoscopy-assisted methods and 9 patients received LABIG using HALS (Group H). We used staplers for the anastomosis, and a standard D2 lymph node dissection was done with ultrasonic shears or electrocautery. RESULTS: In group L, pathologic reports revealed 14 EGC (stage IA 14 cases), and 3 pm cancers (stage IB 1 case, II 2 cases). In group H, there were 9 early gastric cancers (stage IA 8 cases, IB 1 case). Significant differences (P<0.05) were present between group L and H in regards to the number of harvested lymph nodes (30.8 vs 18.9), estimated blood loss (462.1 vs 286.7 ml) and postoperative transfusion amounts (0.59 vs 0 unit). There were no differences in the mean operating time, distance from the lesion to the resection margin, postoperative leukocyte count, frequencies for pain control, wound size, time to diet, weight loss, serum protein, and postoperative hospital stay. Complications were present in 1 case in group L (enterocutaneous fistula) and 1 case in group H (gastric atony). There was one conversion to open surgery in group H. CONCLUSION: LABIG including standard lymph node dissections with both standard laparoscopic surgery and HALS were performed with equal outcome. The choice of surgical method depends on the characteristics of the lesion and the patient's physical factors.

Application of hand-assisted laparoscopic surgery through “Lapdisc” device in abdominal surgery:A report of 78 cases / 中国微创外科杂志

Objective To explore the clinical feasibility of hand-assisted laparoscopic surgery (HALS) through the “Lapdisc” device. Methods HALS was performed in 78 cases. After the establishment of a CO_2 pneumoperitoneum, trocars and a “Lapdisc” device were placed appropriately according to lesion’s location and operative demand. The performance of the “Lapdisc” device during the HALS was examined and clinical effects of the device were evaluated intra- and post-operatively. Results HALS through the “Lapdisc” device was successfully performed in 70 cases. The operation time was 60~240 min (mean, 140 min), the blood loss was 100~300 ml (mean, 186 ml), and the length of hospital stay, 9~15 d (mean, 10.2 d), respectively. Conversions to open surgery were required in 8 cases because of difficulties of laparoscopic performance. Conclusions The “Lapdisc” hand-assisted device has advantages of simplicity of performance, comfortable handling, excellent protection of incision, and stable pneumoperitoneum. and perfect protection to incision. The device can simplify the traditional laparoscopic surgery and be applicable to most abdominal HALS.

Hand-assisted laparoscopic splenectomy for ruptured spleen / 中国微创外科杂志

Objective To explore the feasibility and significance of hand-assisted laparoscopic splenectomy (HALS) for ruptured spleen. Methods We conducted HALS in 18 cases of ruptured spleen between January 2002 and January 2003. According to the Buntain classification of CT-graded splenic injury, 7 cases were classified as “type Ⅱ” and 11 cases, “type Ⅲ”. Ruptured spleen was complicated by other organ injuries in 12 cases. Results The operation was completed successfully in 16 cases, the operation time being 75～115 min (mean, 92.5 min). A conversion to open surgery was made in 2 cases, which were suspected of having injuries of other major vessels. Postoperative time to normal activities was 20～30 days in 6 cases of simple ruptured spleen and 30～100 days in 10 cases of ruptured spleen complicating other injuries. Conclusions HASL is feasible for “type Ⅱ or Ⅲ” ruptured spleen without severe complicating injuries.

Hand-assisted laparoscopic hepatectomy for hepatic hemangioma / 中国普通外科杂志

Objective To evaluate the feasibility, safety, and outcome of hepatectomy by hand-assisted laparoscopic surgery (Lapdisc system) in patients with hepatic hemangioma. Methods Eight patients with hepatic hemangioma underwent hand-assisted laparoscopic hepatectomy. Procedures included introduction of Lapdisc system, isolation of the liver from the ligments, occlusion of the hepatic porta, dissection of the hepatic parenchyma by harmonic scaple and removal of the samples. ResultsIn all patients, the hand-assisted laparoscopic hepatectomy were successfully performed. The operation time was(196.3?81.2)min. Blood loss was (307.5?224.7)ml, and postoperative hospital stay was (7.9?2.9)d. There was no significant postoperative complication such as bile leakage, bleeding or infection. ConclusionsLapdisc system could be safely used for hepatectomy in cases of hepatic hemangioma.

A Case of Total Gastrectomy with Hand-assisted Laparoscopic Surgery (HALS) for the Patient with Early Gastric Cancer / 日本農村医学会雑誌

The patient was a 63-years-old female with early gastric cancer in her upper stomach. Widely spreading on the mucous membrane, the cancer was too big to remove by endoscopical mucosal resection, although she wanted minimal invasive treatment. Therefore, we adopted total gastrectomy with hand-assisted laparoscopic surgery (HALS) after obtaining “informed consent” from her. Five small skin-incisions were necessary to perform it-one 7cm' for hand-port and four 1.2cm' for trocars.<BR>The dissection was started from greater omentum and proceeded counterclockwise to remove primary lymphnodes. The abdominal esophagus and the duodenum were devided with a single or double application of Endo GIA stapler (linear stapler). All these steps were accomplished safely and securely with the effective support of the left hand of the operator. After extraction of the whole stomach through the 7cm-incision, Roux-en Y reconstruction was performed laparoscopically (esophago-jejunostomy) followed by hand sewing through the 7cm-incision (jejuno-jejunostomy). The anvil of 21mm circular stapler (EEA) was inserted orally in order to anastomose the esophagus to the jejunum. The patient had acceptable results intra-operatively as well as postoperatively by HALS total gastrectomy, which had been considered to be very hard to perform up to present time.

Hand-Assisted Laparoscopic Surgery (HALS) with the HandPort System

PURPOSE: The purpose of this study was to evaluate the feasibility and potential benefits of Hand-Assisted Laparoscopic Surgery (HALS) with the HandPort system. The surgeon inserts the nondominant hand into the abdomen while the pneumoperitoneum is maintained. The hand assists laparoscopic instruments and is helpful in complex laparoscopic surgery. This approach provides an excellent means to explore, to retract safely, and to apply immediate hemostasis when needed. METHODS: A prospective study was performed in patients who had undergone surgical intervention with the HandPort system at Ewha Womans University Mok-Dong Hospital. The surgeon was free to test the device in any situation where they expected a potential advantage over conventional laparoscopy. The surgeon inserted the nondominant hand into the abdomen while the pneumoperitoneum was generally maintained at 13 mmHg. RESULTS: Thirteen patients were entered in the study. Operations included radical gastrectomy in 8 cases, subtotal gastrectomy in 1 case, hemicolecotmy in 2, distal pancreatectomy with splenectomy in 1, nephrectomy with splenectomy in 1. The mean incision size for the HandPort device was 7.5 cm for the nondominant hand. None of the patients required conversion to open surgery as a result of an unmanageable air leak. There were no postoperative problems and no cases of mortality. CONCLUSION: HALS with the HandPort system is helpful in complex laparoscopic surgery and appeared to be useful in minimally invasive procedures considered too complex for,a laparoscopic approach.