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. 2024 Jul 30;8(3):228-234.
doi: 10.23922/jarc.2024-024. eCollection 2024.

Usefulness of Hand-assisted Laparoscopic Restorative Proctocolectomy for Ulcerative Colitis in the Era of Laparoscopic Surgery - A Single-center Observational Study

Hideaki Kimura  1 , Kenichiro Toritani  1 , Itaru Endo  2
Affiliations

Usefulness of Hand-assisted Laparoscopic Restorative Proctocolectomy for Ulcerative Colitis in the Era of Laparoscopic Surgery - A Single-center Observational Study

Hideaki Kimura et al. J Anus Rectum Colon. .

Abstract

Objectives: Hand-assisted laparoscopic surgery (HALS) combines the benefits of laparoscopic surgery with the tactile feedback from open surgery. In the current era of laparoscopic surgery, the significance of HALS as a technical transition has diminished. This study clarified the usefulness of HALS in restorative proctocolectomy (RPC) for ulcerative colitis (UC) in the era of laparoscopic surgery.

Methods: The 212 patients who underwent RPC with ileal pouch-anal anastomosis between 2007 and 2023 were included in this study. The patients were divided into three groups, open surgery (OS), HALS, and conventional laparoscopic surgery (LAP), and their characteristics, surgical outcomes, surgical complications, and functional outcomes were compared.

Results: The number of surgical techniques was OS in 21 cases, HALS in 184 cases, and LAP in 7 cases. The number of surgeons was two for OS and HALS, and four for LAP, with OS and HALS having fewer surgeons than LAP. The length of the skin incision was 13, 7, and 3 cm for OS, HALS, and LAP, respectively, and the operation times was 250, 286, and 576 minutes for OS, HALS, and LAP, respectively, with LAP having the longest operation time. The postoperative complications and function did not differ markedly among the three groups.

Conclusions: In RPC for UC, HALS involved fewer surgeons and a shorter operative time than LAP. Even in the era of laparoscopic surgery, HALS remains a useful option, especially when a shorter operation time is required or when the number of available surgeons is insufficient.

Keywords: HALS; era of laparoscopic surgery; hand-assisted laparoscopic surgery; restorative proctocolectomy; ulcerative colitis.

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Conflict of interest statement

Conflicts of Interest There are no conflicts of interest.

Figures

Figure 1.
Figure 1.
Flowchart of the study selection process. Cases of total proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis were performed (n = 212) were included in this study.
Figure 2.
Figure 2.
Port and incision placement for hand assisted laparoscopic surgery. We use three 5-mm ports in addition to a 6- to 7-cm lower longitudinal incision for the hand port.
See this image and copyright information in PMC

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