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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.
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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.
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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.