Hand-assisted Laparoscopic Surgery-a Novel Blessing Technique For Novice Surgeons In Our Modern Era

The technical complexity and protracted learning curve before achievingperfection in laparoscopic surgery (LS) have paved the way to thedevelopment of hand-assisted laparoscopic surgery (HALS), which hasevolved as a hybrid of open and laparoscopic approach, while keeping theconvenience and safety of the former and advantages of minimallyinvasive surgery (MIS) of the latter. As its name implies, this noveltechnique allows the surgeon to introduce the non-dominant hand into theabdominal cavity to assist the surgery through a hand-assisted devicewhile maintaining pneumoperitoneum. The purpose of this study was toexamine the results of a single surgeon’s experience with hand-assistedlaparoscopic left colon resection for malignancy; as it is one of the mostchallenging procedure due to the narrow pelvis and complex anatomy. Weconducted a retrospective analysis of30specific selected cases ofcolorectal carcinoma confined to the left side involving the descendingcolon, sigmoid colon and rectum5cm above the anal margin; whichunderwent hand-assisted laparoscopic resection between September2010 and December2011, using the Dextrus (Ethicon Endo-Surgery, INC,USA) hand-assisted device (HAD). The clinical records were criticallyreviewed and analyzed in terms of the most important operative andpostoperative evaluation parameters. We observed a remarkable operativetime of110minutes after only15cases done with a minimal blood loss of100ml and achieved a100%success rate as there were no intra-operativecomplications necessitating conversion to open technique and as well asno postoperative complications noted till date. Hence, we concluded thathand-assisted laparoscopic surgery is a highly reliable, feasible and awin-win approach to both the surgeon and the patient; furthermore ahelping hand inside the abdomen is a psychological inspiration inciting theconfidence of novel surgeons, initiating them to cross the bridge towardsmore complex advanced laparoscopic surgery, while it can be the lastresort for an experienced laparoscopist in very difficult cases.