title: Three-step hand-assisted laparoscopic surgery for radical distal gastrectomy: an effective surgical approach.
abstract: OBJECTIVE
  Three-step hand-assisted laparoscopic D2 radical gastrectomy (HALG) is a modified surgical technique based on hand-assisted laparoscopic surgery (HALS) for the treatment of gastric cancer. This surgical approach is particularly easy and convenient for radical distal gastrectomy. In order to thoroughly understand the advantages of applying "three-step HALG" in distal gastrectomy, our center conducted a retrospective study to analyze data from patients who underwent HALG and laparoscopic-assisted D2 radical gastrectomy (LAG) during the corresponding time period.
  
  
  METHODS
  The HALG procedure is performed in three steps, namely the operation performed through an auxiliary incision under direct vision, hand-assisted laparoscopic operation, and gastrointestinal tract reconstruction through the auxiliary incision under direct vision. This study performed comprehensive, in-depth comparative analyses on the clinical data of two groups of patients who underwent HALG and LAG.
  
  
  RESULTS
  The auxiliary incision under the xiphoid was maximally utilized in the HALG procedure. The rate of conversion to open surgery in HALG group patients was significantly lower than in the LAG group (P = 0.03), and the operating time was significantly shorter in the HALG group than in the LAG group (P = 0.00). There was no significant difference in the pain rate score on postoperative day 2 and on the day of discharge between the HALG and LAG groups (P > 0.05). No statistically significant difference was found in the time to recovery of bowel function, postoperative hospital stay, or postoperative complications (P > 0.05), although the values were all lower in the HALG group than in the LAG group.
  
  
  CONCLUSIONS
  "Three-step HALG" is a highly feasible surgical approach for radical distal gastrectomy.
authors.affiliation: Center of General Surgery, The People's Liberation Army General Hospital of Chengdu Command Chengdu 610083, Sichuan, China.
authors.forename: Jia-Qing
authors.initials: JQ
authors.lastname: Gong
authors.affiliation: Center of General Surgery, The People's Liberation Army General Hospital of Chengdu Command Chengdu 610083, Sichuan, China.
authors.forename: Yong-Kuan
authors.initials: YK
authors.lastname: Cao
authors.affiliation: Center of General Surgery, The People's Liberation Army General Hospital of Chengdu Command Chengdu 610083, Sichuan, China.
authors.forename: Yong-Hua
authors.initials: YH
authors.lastname: Wang
authors.affiliation: Center of General Surgery, The People's Liberation Army General Hospital of Chengdu Command Chengdu 610083, Sichuan, China.
authors.forename: Guo-Hu
authors.initials: GH
authors.lastname: Zhang
authors.affiliation: Center of General Surgery, The People's Liberation Army General Hospital of Chengdu Command Chengdu 610083, Sichuan, China.
authors.forename: Pei-Hong
authors.initials: PH
authors.lastname: Wang
authors.affiliation: Center of General Surgery, The People's Liberation Army General Hospital of Chengdu Command Chengdu 610083, Sichuan, China.
authors.forename: Guo-De
authors.initials: GD
authors.lastname: Luo
keywords: Hand-assisted laparoscopic surgery; distal gastrectomy; laparoscopic-assisted D2 radical gastrectomy; three-step hand-assisted laparoscopic D2 radical gastrectomy