title: Hand-assisted laparoscopic restorative proctocolectomy for ulcerative colitis: the optimization of instrumentation toward standardization.
abstract: OBJECTIVE
  Hand-assisted laparoscopic surgery (HALS) is increasingly used for complex and extensive colorectal diseases, such as a restorative proctocolectomy (RP) for ulcerative colitis (UC). However, the optimal instrumentation for this procedure has yet to be determined. This study reviewed the optimization of the instrumentation employed for HALS-RP and evaluated their impact in standardizing HALS-RP for UC.
  
  
  METHODS
  Sixty-six cases with HALS-RP for UC were reviewed. Cases were divided into subgroups according to (1) hand-access devices and (2) vascular control devices, and their intraoperative/postoperative outcomes were compared.
  
  
  RESULTS
  All groups had comparable backgrounds. (1) The hand-access devices employed were first LapDisc (n = 14), then HandPort (n = 25), and recently GelPort (n = 27). The surgical time was shortest in GelPort group in comparison to the other two groups. (2) Laparosonic coagulating shears (LCS) with clips were used for vascular control in the first 29 patients, and the bipolar vessel sealing system (LigaSure) was employed in the 37 subsequent patients. The surgical time was shorter and blood loss was less in the LigaSure group. No differences were seen in postoperative outcomes, including the complication rate and length of hospital stay.
  
  
  CONCLUSIONS
  The new instrumentation contributed to improved outcome of HALS-RP. HALS-RP can become a more comfortable and standardized procedure for UC with the adoption of evolving technologies.
authors.affiliation: Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Nakajima
authors.forename: Riichiro
authors.initials: R
authors.lastname: Nezu
authors.forename: Toshinori
authors.initials: T
authors.lastname: Ito
authors.forename: Toshirou
authors.initials: T
authors.lastname: Nishida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult