Hand-assisted Laparoscopic Surgery Procedures Research Articles

Splenic Primary Solid Tumors : Does a Preoperative Histopathology Diagnosis Really Matter?

The present study aims to present a case series of patients who underwent splenectomy for splenic primary solid tumors without preoperative histopathologic diagnosis. From 2013 to 2019, 12 patients underwent splenectomy for solid primary splenic tumors at 3 different academic medical centers. All electronic medical records were retrospectively reviewed. Seven (58.3%) patients were women, and 5 (41.6%) were male. The median age was 48 years (range: 25-72 years). In 8 (66.6%) patients, a conventional approach was performed. In 2 (16.6%), a hand-assisted laparoscopic surgery procedure was completed, and in other 2 (16.6%) patients, a laparoscopic approach was auspiciously achieved. Median operative time was 135 minutes (range: 60-210 minutes), and median blood loss was 500 mL (range: 200-1500 mL). Procedure-related morbidity was found in 2 (16.6%) patients, and the mortality rate was 0%. The final histopathologic diagnosis was lymphoma in 5 (41.6%) patients, lymphangioma in 3 (25%) patients, hamartoma in 2 (16.6%) patients, angiosarcoma, and sclerosing angiomatoid nodular transformation (SANT) in 1 (8.3%) case each. Splenectomy should be the treatment of choice when encountering a primary splenic tumor without the need for preoperative fine-needle aspiration biopsy, avoiding the complications this technique entails.

Hand-Assisted Laparoscopic Right Colectomy: Is It Useful?

See Article on Page 11-17 These days, minimally invasive surgery (MIS) has become the standard surgical procedure in Korea for patients with colon cancer. Among various techniques for MIS, conventional laparoscopic surgery (CLS) has gained in popularity. Furthermore, high-quality articles regarding outcomes of MIS for colorectal cancer treatment that were written by Korean surgeons have been published in leading medical journals [1, 2]. On the other hand, hand-assisted laparoscopic surgery (HALS) is still infrequently implemented in Korea because its position as a surgical option is still unsettled. In the literature, whether or not the HALS procedure is useful for a right colectomy is a subject of controversy. Ng et al. [3] reported that a HALS right colectomy did not confer additional advantages over a laparoscopic right colectomy in terms of clinical, operative or oncological outcomes. For this reason, the routine use of the hand-assisted laparoscopic technique for treating right colonic cancers cannot be recommended. Vogel et al. [4] conduct a similar study, and the short-term outcomes of a HALS and a CLS right colectomy were similar. However, they arrived at a different conclusion in that they recommended that the decision to perform a HALS or a CLS right colectomy should be based on the surgeons' preference and not on the perception that one technique was preferable to the other. In this present study, the HALS group included more advanced cancers than the CLS group did. Thus, the authors' conclusions were similar to those of Ng et al. [3] in that the HALS technique had an advantage for treating complex and extensive cancers only [5]. From a CLS surgeon's point of view, it was only natural for CLS surgeons to come to this conclusion. CLS surgeons are used to performing CLS, so they feel no need to conduct HALS. However, the similar clinical outcomes for CLS and HALS do not mean that HALS is an unnecessary procedure; rather, it means that surgeons can choose the procedure they like. Thus, although I agree with the authors' conclusion in this present study, if the true value of a HALS right colectomy is to be determined, a comparative, prospective study should be conducted on the two groups under equal conditions.

Incisional Hernia Risk after Hand-Assisted Laparoscopic Surgery

Hand-assisted laparoscopic surgery (HALS) bridges traditional open surgery and pure laparoscopy. The HALS technique provides the necessary site for organ retrieval, reduces operative time, and realizes the postoperative benefits of laparoscopic techniques. Although the reported rates of incisional hernia should be theoretically low, we sought to determine our incidence of hernia after HALS procedures. A retrospective review of all HALS procedures was performed from July 2006 to June 2011. All patients who developed postoperative incisional hernias at the hand port site were confirmed by imaging or examination findings. Patient factors were reviewed to determine any predictors of hernia formation. Over the 5 years, 405 patients undergoing HALS procedures were evaluated: colectomy (264), nephrectomy (107), splenectomy/pancreatectomy (18), and ostomy reversal (10). The overall incidence of incisional hernia was 10.6 per cent. There were three perioperative wound dehiscences. The mean body mass index was significantly higher in the hernia group versus the no hernia cohort (32.1 vs 29.2 kg/m(2); P = 0.001). The hernia group also had a higher incidence of renal disease (18.6 vs 7.2%; P = 0.018). Mean time to hernia formation was 11.4 months (range, 1 to 57 months). Follow-up was greater than 12 months in 188 (46%) of patients, in which the rate of incisional hernia was 17 per cent. The rate of incisional hernia formation after hand-assisted laparoscopic procedures is higher than the reported literature. Because the mean time to hernia development is approximately 1 year, it is important to follow these patients to this end point to determine the true incidence of incisional hernia after hand-assisted laparoscopy.

Elective living donor liver transplantation by hybrid hand-assisted laparoscopic surgery and short upper midline laparotomy

Although the technique of liver transplantation is well developed, the invasiveness of the operation can be decreased with laparoscopic procedures. We performed elective living donor liver transplantation (LDLT) through a short midline incision combined with hand-assisted laparoscopic surgery (HALS). Nine selected patients with end stage liver disease underwent the procedure between July, 2010 and February, 2011 (median age 60, median Child-Pugh 9, median MELD score 14). Splenectomy was performed simultaneously in 7 cases. The liver (and spleen) were mobilized by a sealing device under a HALS procedure with an 8-cm upper midline incision, followed by explantation of the diseased liver (and spleen) through the upper midline incision which was extended to 12 to 15 cm. Partial liver grafts were implanted through the upper midline incision. The median duration of the operation was 741 minutes, the median time needed for anastomosis was 48 minutes, the median blood loss was 3,940 g, and the median liver weight was 866 g. Eight recipients are alive and have good graft function. A difficult implantation for one patient required an additional right transverse incision. When compared with 13 recent liver recipients who underwent LDLT with a regular Mercedes-Benz-type incision, no clinically relevant drawbacks of the HALS hybrid procedure were observed. We have shown the feasibility and safety of LDLT performed through a short midline incision without abdominal muscle disruption with the aid of HALS.

Hand-assisted laparoscopic colon and rectal cancer surgery: Feasibility, short-term, and oncological outcomes

Hand-assisted laparoscopic surgery (HALS) is an established alternative to laparoscopic-assisted surgery, but limited data exist regarding its applicability for colorectal cancer (CRC). We report short-term outcomes in a large series of CRC patients who underwent HALS between 2004 and 2009. A prospectively maintained database was used to identify all CRC patients. Patients with colon cancer (CC) and rectal cancer (RC) were considered separately. Three patients with synchronous CC and RC were excluded. Data are frequency (%) or median (interquartile range). Between 2004 and 2009, 323 CRC patients underwent a HALS procedure. Median age was 65 (53-73) years, 39% were women, and the median BMI was 27 (24-31) kg/m(2). Diagnoses included 194 colon cancers (CC, 56.7% stage I/II), 129 rectal cancers (RC, 62.7% stage I/II). Operative time was less for CC than RC (157 vs 204 min; P < .0001). Conversion to laparotomy occurred in similar proportions of CC and RC cases (14% vs 10%; P = .38); lymph nodes retrieval was also similar (18 vs 18; P = .45). Overall duration of stay was 5 (4-7) days. At 30 days, postoperative complications occurred in similar proportions of CC and RC patients (28% vs 30%; P = .72). There was 1 mortality (0.5%). For the subgroup with 3 year follow-up, (73 CC and 45 RC patients), the overall survival was 80% and 88% (CC and RC, respectively), and disease free survival 79% and 85%, respectively. Colon and rectal cancer can be resected safely using HALS techniques. Conversion rates are low, complication rates expected, durations of hospital stay shorter, and the number of lymph nodes retrieved is high.

The role of hand-assisted laparoscopic surgery in subtotal and total colectomy for Crohn’s colitis

Hand-assisted laparoscopic surgery (HALS) has gained wide clinical acceptance as a practical alternative to laparoscopically assisted surgery (LAP) for the surgical treatment of complex colorectal diseases (e.g., ulcerative colitis and diverticulitis). However, its role in the further challenging operation for Crohn's colitis (i.e., subtotal or total colectomy) has yet to be established. This study aimed to evaluate the feasibility, safety, and potential benefit of HALS subtotal and total colectomy for Crohn's colitis. The study reviewed 38 consecutive patients who underwent subtotal or total colectomy as their initial abdominal surgery for Crohn's extensive colitis (involvement of 3 or more colonic segments) between 1992 and 2006. The patients were divided into three groups (open, LAP, and HALS), and their background and postoperative data were retrospectively analyzed. The reviews included 14 open, 6 LAP, and 18 HALS cases. The groups were comparable in terms of age at surgery, gender, body mass index, extent and type of disease, indications, and procedures. The median operative time was significantly longer for LAP (330 min; range, 154-540 min) than for HALS (251 min; range, 165-340 min) or open surgery (200 min; range, 172-315 min). The blood loss was significantly less with LAP (170 ml; range, 115-257 ml) and HALS (225 ml; range, 35-890 ml) than with open surgery (438 ml; range, 280-780 ml). No difference was seen in postoperative complications, and no mortality occurred in the series. The findings showed that HALS subtotal and total colectomies are feasible and safe. The HALS procedure currently seems potentially beneficial for patients with extensive Crohn's colitis by reducing the operative time for laparoscopic surgery while retaining its less invasiveness.

Feasibility of hand-assisted laparoscopic surgery (HALS) in gynecologic oncology patients

5153 Objective: Although hand-assisted laparoscopic surgery (HALS) has been utilized in multiple surgical procedures, limited data exists on the use of HALS for gynecologic oncology indications. Our goal was to evaluate the indications, potential benefits, and complications of HALS in cases of suspected gynecologic malignancy. Methods: We performed a retrospective chart review of patients who had an HALS procedure performed from 1/03 until 10/04. Data was collected on patient demographics, indications for surgery, operative morbidity, and length of stay. Results: 37 patients who underwent a HALS procedure were identified. The median age was 51 years (range, 19–86) and the mean BMI was 28.7 m2 (range, 17.8–40.7). The indications for surgery included pelvic mass (n=29), prophylactic oophorectomy (n=2), secondary cytoreduction for ovarian cancer (n=2), uterine fibroids (n=2), surgical staging for endometrial cancer (n=1), post-menopausal bleeding (n=1), and vaginal vault prolapse (n=1). The mean estimated size of pelvic mass removed was 11.2 cm (range, 3–30). 6 of 29 (21%) patients with a pelvic mass were diagnosed with an ovarian carcinoma. All patients underwent general endotracheal anesthesia for the following procedures performed: oophorectomy (n=31), lysis of adhesions (n=14), surgical staging (n=9), hysterectomy (n=9), loop colostomy (n=1), and sacrocolpo suspension (n=1). Mean operating time was 90 minutes (range, 46–157) with mean estimated blood loss of 110 cc (range, 10–400). One patient was converted to laparotomy due to a large unresectable mass. One intraoperative complication of epigastric vessel injury due to trocar placement occurred. The average length of post-operative hospital stay was 2.8 days (range, 2–5). 4 of 37 (11%) patients experienced a post-operative complication including ileus (n=2), pre-renal azotemia (n=1), and transfusion of packed red blood cells (n=1). Conclusions: HALS is an innovative surgical technique that allows a number of surgical procedures to be accomplished in gynecologic oncology patients. HALS appears to be safe and feasible based on acceptable operating time, estimated blood loss, conversion rate, complication rate, and length of hospital stay. No significant financial relationships to disclose.

Hand-assisted laparoscopic surgery using Gelport.

Introduction:Minimally invasive surgery has revolutionized general surgery during the past 10 years. However, for more advanced surgical procedures, the acceptance of the minimally invasive approach has been slower than expected. Advanced laparoscopic surgery is complex and time-consuming. The major drawbacks of laparoscopic surgery are two-dimensional view, lack of depth perception and loss of tactile sensation. This has led to the innovation of hand-assisted laparoscopic surgery (HALS). The objective of the present study was to determine that safety of HALS.Materials and Methods:We preformed 18 HALS procedures in our department between July 2003 and January 2005 on patients who had given their informed consent for the use of Gelport. Out of these, 15 were colectomy, 2 nephrectomy and 1 splenectomy. Out of the 18 patients, 13 were males and 5 were females with the age group ranging from 44 to 72 years.Results:Hand-assisted laparoscopic surgery could be completed in 17 patients maintaining all the oncological principals of surgery. The mean operating times were 120 min for right haemicolectomy, 135 min for left colectomy, 150 min for splenectomy, and 150 min for nephrectomy. The patient undergoing radical nephrectomy by HALS had to be converted to open surgery. As the tumour was large and adherent to the spleen and posterior peritoneal wall. Postoperative recovery was excellent with an average hospital stay of 5 days. Histopathology report showed wide clearance and till date we have a good follow up of 30–380 days.Conclusion:Hand-assisted laparoscopic surgery allows tactile sensation and depth perception thereby may simplify the complex procedures. This may result in reduction of operating time and conversion rates at the same time maintaining all the oncological principles. Hand-assisted laparoscopic surgery strikes a perfect balance between an extended open laparotomy incision and an excessively tedious laparoscopic exercise. Hand assistance is an initial tool for the trainee laparoscopic surgeon or a last resort for the experienced laparoscopic surgeon.

Hand-assisted laparoscopic colorectal surgery using GelPort.

An easily usable hand access device will optimize success in hand-assisted laparoscopic surgery (HALS). The authors describe their initial series of HALS colorectal resections using GelPort to evaluate their current technique and results with this new device. A retrospective study investigated 33 HALS colorectal procedures including total colectomy ( n = 16) and low anterior resection ( n = 10). All operative data, including intraoperative GelPort performance, were prospectively recorded and retrospectively analyzed. In this study, 3 (9.1%) of 33 HALS procedures were converted to open surgery, and 4 (13.3%) of 30 HALS procedures required minimal enlargement of incisions to facilitate extracorporeal procedures. The operative time was 263 +/- 85 min, and the blood loss was 282 +/- 148 ml. There were no device malfunctions. Three major complications (9.1%) and 7 minor wound infections (21%) were noted postoperatively. The mean hospital stay was 7.9 +/- 3.8 days. When performed with GelPort, HALS is safely and reliably applicable for various colorectal procedures.

Grasping and dissecting instrument for hand-assisted laparoscopic surgery: development and early clinical experience.

The operative potential of hand-assisted laparoscopic surgery (HALS) could be enhanced by the introduction of a new generation of assisting instruments. These tools will have to meet specific requirements of shape, function, and safety of use. Problems related to the working environment of HALS and deriving projectual restrictions of HALS instruments were analyzed in order to develop and manufacture a working prototype with grasping and dissecting properties to assist during HALS procedures. The resulting instrument was mechanically and clinically tested in 22 HALS procedures. The additional benefit of the new device was particularly appreciated during dissection and isolation of vascular pedicles (nephrectomies and splenectomies). It was shown to be safe and effective in providing the additional assistance it was designed for. The described grasping and dissecting instrument for HALS is of great value in assisting the surgeon during fine dissection, as required in selected procedures. New generation of HALS instruments should comply with the functional and safety issues analyzed in this report.

Hand-Assisted Laparoscopic Surgery in the United States: An Overview

Hand-assisted laparoscopic surgery (HALS) was developed to bridge the gap between open surgery and advanced laparoscopic surgery. Advantages of the hand in the abdomen include tactile feedback, the ability to palpate, blunt dissection, organ retraction, control of bleeding, and rapid organ removal. There are 3 commercially available devices in the United States, as well as a fourth in Europe and a fifth in Japan. Uses for HALS include procedures requiring intact specimen removal, complex laparoscopic procedures, preventing open conversion, and overcoming a technical obstacle. HALS procedures, such as esophagectomy, gastrectomy, hepatectomy, pancreatectomy, splenectomy, bariatric surgery, colectomy, nephrectomy, hysterectomy, and aortobifemoral bypass, have all been reported in the literature. Improvement in instrumentation, specifically with newer generation devices, will allow HALS to become more popular. We advocate the use of HALS specifically for laparoscopic colectomy, laparoscopic splenectomy for massive splenomegaly, and for living-related donor nephrectomy.