Hand-assisted laparoscopic surgery (HALS): a report of 150 procedures.
BACKGROUND
This study was performed to evaluate the (long-term) morbidity associated with hand-assisted laparoscopic surgery (HALS) for various indications.


METHODS
HALS procedures for various indications were evaluated prospectively from 1995 to 2002. The primary outcome parameters were postsurgical complications and the development of incisional hernias.


RESULTS
Twenty-six splenectomies, 51 hand-assisted laparoscopic donor nephrectomies (HLDN), 34 segmental bowel resections, 29 proctocolectomies, and 10 emergency colectomies were evaluated. A Küstner or Pfannenstiel incision was used for handport placement. Minor complications (i.e., wound complications, urinary tract infection) occurred in 15%, 12%, 26%, 7%, and 33% of the patients after, respectively, splenectomy, HLDN, bowel resection, proctocolectomy, and emergency colectomy. Major complications (i.e., hemorrhage, anastomotic leakage) occurred in 15% and 12% of the patients after, respectively, bowel resection and proctocolectomy. Incisional hernias occurred in six patients (4%), all after a wound complication in the Küstner incision.


CONCLUSIONS
HALS is fast, safe, and feasible for various indications, especially HLDN and (procto-)colectomies. Little advantage can be expected when HALS is applied in splenectomy and segmental bowel (sigmoid) resection.
Maartense
S
S
Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
Bemelman
W A
WA
Gerritsen van der Hoop
A
A
Meijer
D W
DW
Gouma
D J
DJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000379:methods; D004630:Emergencies; D005260:Female; D006225:Hand; D006801:Humans; D007081:Ileostomy / Q000379:methods; D007420:Intestine, Large / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D007858:Learning; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013156:Splenectomy / Q000379:methods; D020858:Tissue and Organ Harvesting / Q000379:methods