title: Hand-assisted laparoscopic abdomino-perineal resection utilizing the planned end colostomy site.
abstract: BACKGROUND
  Aim of the study was to determine the feasibility and outcomes of utilizing the planned end colostomy site for placing the hand-assist device in performing hand-assisted laparoscopic abdominoperineal resections (HAL APR) in patients with low rectal cancer.
  
  
  METHODS
  Patients with low rectal cancers not suitable for a sphincter salvage proctectomy were recruited. HAL APR was performed by placing the hand-assist device over the planned colostomy site. Standard total mesorectal excision (TME) was performed, and the specimen was delivered via the perineal incision. Patient data and perioperative variables were obtained from the institution colorectal cancer database and analyzed.
  
  
  RESULTS
  Six patients underwent HAL APR from November 2004 to January 2006. Mean operative time was 213 min with no conversions or intraoperative complications. One patient developed post-operative ileus which resolved spontaneously. There were no other morbidities or mortalities. Mean hospitalization was 6.8 days. After a mean follow-up of 13.3 months, one patient developed a parastomal hernia which was subsequently repaired during liver resection for liver metastases. No other long-term complications occurred.
  
  
  CONCLUSIONS
  HAL APR with the hand device placed at the planned stoma site is technically feasible. Without creating an additional incision, the operation is oncologically comparable and renders similar short-term outcomes as SL methods, maintaining the benefits of a minimally invasive approach.
authors.affiliation: Department of Surgery, National University Hospital, Singapore, Singapore. surkohd@nus.edu.sg
authors.forename: D C
authors.initials: DC
authors.lastname: Koh
authors.forename: C-W
authors.initials: CW
authors.lastname: Law
authors.forename: I
authors.initials: I
authors.lastname: Kristian
authors.forename: W-K
authors.initials: WK
authors.lastname: Cheong
authors.forename: C B
authors.initials: CB
authors.lastname: Tsang
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003125:Colostomy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D054047:Surgical Stomas; D016896:Treatment Outcome