title: Hand-assisted laparoscopic surgery for complex gallstone disease: a report of five cases.
abstract: OBJECTIVE
  To describe the use of hand-assisted laparoscopic surgery (HALS) as an alternative to open conversion for complex gall-stone diseases, including Mirizzi syndrome (MS) and mimic MS.
  
  
  METHODS
  Five patients with MS and mimic MS of 232 consecutive patients undergoing laparoscopic cholecystectomies were analyzed. HALS without a hand-port device was performed as an alternative to open conversion if the anatomy was still unclear after the neck of the gallbladder was reached.
  
  
  RESULTS
  HALS was performed on three patients with MS type I and 2 with mimic MS owing to an unclear or abnormal anatomy, or an unusual circumstance in which an impacted stone was squeezed out from the infundibulum or the aberrant cystic duct impossible with laparoscopic approach. The median operative time was 165 min (range, 115-190 min). The median hand-assisted time was 75 min (range, 65-100 min). The median postoperative stay was 4 d (range, 3-5 d). The postoperative course was uneventful, except for 1 patient complicated with a minor incision infection.
  
  
  CONCLUSIONS
  HALS for MS type I and mimic MS is safe and feasible. It simplifies laparoscopic procedure, and can be used as an alternative to open conversion for complex gallstone diseases.
authors.affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China. weiqi@hzcnc.com
authors.forename: Qi
authors.initials: Q
authors.lastname: Wei
authors.forename: Lai-Gen
authors.initials: LG
authors.lastname: Shen
authors.forename: He-Ming
authors.initials: HM
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D042882:Gallstones / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications