title: Hand-assisted laparoscopic surgery versus open surgery for colorectal disease: a systematic review and meta-analysis.
abstract: BACKGROUND
  Laparoscopic colorectal surgery remains one of the most challenging techniques to learn.
  
  
  METHODS
  The authors collected studies that have compared hand-assisted laparoscopic surgery (HALS) and open surgery for the treatment of colorectal disease over the past 17 years. Data of interest for HALS and open surgery were subjected to meta-analysis.
  
  
  RESULTS
  Twelve studies that included 1,362 patients were studied. In total, 2.66% of HALS procedures were converted to laparotomy. Compared with the open surgery group, blood loss, rate of wound infection, and ileus in the HALS group decreased, and incision length, recovery of gastrointestinal function, and hospitalization period were shorter. There were no significant differences in operating time, hospitalization costs, mortality, and complications, including urinary tract infection, pneumonia, and anastomotic leak, between the groups.
  
  
  CONCLUSIONS
  HALS has the advantages of minimal invasion, lower blood loss, shorter incision length, and faster recovery, and it can shorten the length of hospitalization without an increase in costs. The drawbacks are that a small number of patients who undergo HALS may need to be converted to laparotomy, and the oncologic safety and long-term prognosis are not clear.
authors.affiliation: Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital, Guiyang, China; Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Ding
authors.affiliation: Department of Stomatology, Guizhou Provincial People's Hospital, Guiyang, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Xia
authors.affiliation: Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China. Electronic address: guoqingliao@126.com.
authors.forename: Guo-qing
authors.initials: GQ
authors.lastname: Liao
authors.affiliation: Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital, Guiyang, China. Electronic address: zhangzhongmin@medmai.com.cn.
authors.forename: Zhong-min
authors.initials: ZM
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Zhong-shu
authors.initials: ZS
authors.lastname: Yan
mesh_terms: D003107:Colorectal Surgery / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D061887:Conversion to Open Surgery; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D061646:Operative Time
keywords: Colon; Colorectal; Hand-assisted laparoscopic surgery; Laparoscopy; Meta-analysis; Open surgery