title: [Hand assistance is an alternative to conversion to laparotomy during laparoscopic sigmoidectomy].
abstract: BACKGROUND
  Laparoscopic surgery in the treatment of diverticular disease offers multiple benefits compared with its open surgery counterpart. There are two distinct techniques, the laparoscopically assisted and the laparoscopic hand assisted approach. The purpose of this study is to demonstrate that the hand assisted approach can be used if, during a laparoscopically assisted approach, there is difficulty in dissection and/or exposure, and before performing a laparotomy.
  
  
  METHODS
  This study is a retrospective cohort series that was performed in a private tertiary hospital in Mexico City. Patients with the diagnosis of diverticular disease who underwent a laparoscopically assisted sigmoidectomy were selected. These included patients who, during their procedure required conversion to a hand assisted approach.
  
  
  RESULTS
  A total of 47 sigmoid colectomies began with assisted laparoscopy, of which 33 were completed, 4 required laparotomy, and 10 where completed using hand assistance (none required laparotomy). There were no statistically significant differences in return of bowel function (P=0.879) and postoperative hospital stay (P=0.679) between the group that was completed by assisted laparoscopy vs. hand assisted.
  
  
  CONCLUSIONS
  If there is difficulty in exposure or dissection during a laparoscopically assisted sigmoid colectomy, the hand assisted approach is an alternative before the laparotomy.
authors.affiliation: American British Cowdray Medical Center I.A.P., México D.F., México. dradrianmurillo@gmail.com
authors.forename: Adrián
authors.initials: A
authors.lastname: Murillo Zolezzi
authors.forename: Pablo Daniel
authors.initials: PD
authors.lastname: Murakami Morishige
authors.forename: Sergio Alejandro
authors.initials: SA
authors.lastname: Toledo Valdovinos
authors.forename: Hernán
authors.initials: H
authors.lastname: Maydon González
authors.forename: Carlos
authors.initials: C
authors.lastname: Belmonte Montes
mesh_terms: D015331:Cohort Studies; D012809:Colon, Sigmoid / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies