| Published: | June 2008 - Diseases of the Colon & Rectum |
| Excerpt: | “In this prospective, randomized study, hand-assisted laparoscopic colorectal surgery resulted in significantly shorter operative times while maintaining similar clinical outcomes as straight laparoscopic techniques for patients undergoing left-sided colectomy and total abdominal colectomy. There were no apparent differences in the time to return of bowel function, tolerance of diet, length of stay, postoperative pain scores, or narcotic usage between the hand-assisted laparoscopic and straight laparoscopic groups. A hand-assisted laparoscopic approach may be considered another tool in the surgeon’s armamentarium of minimally invasive techniques for the treatment of colorectal diseases.” |
| Published: | November 2022 - International Journal of Colorectal Disease |
| Excerpt: | “A total of 47 studies were found fitting the inclusion criteria, with 5 RCTs [randomized controlled trials], 41 cohort studies and 1 case series. Hand-assisted laparoscopic surgery was associated with lower conversion rates, shorter operative times and higher BMI … Length of stay was not different in HALS as compared to lap[aroscopy], and intraoperative complications were the same between both techniques.” |
| Published: | April 2008 - Surgical Endoscopy |
| Excerpt: | “This systematic review indicates that HALS provides a more efficient segmental colectomy regarding operating time and conversion rate, particularly accounting for diverticulitis. A significant operating time advantage exists for HALS total (procto)colectomy. HALS must therefore be considered a valuable addition to the laparoscopic armamentarium to avoid conversion and speed up complicated colectomies.” |
| Published: | September 2011 - Diseases of the Colon and Rectum |
| Excerpt: | “Hand-assisted laparoscopic colorectal resection can be performed for numerous indications. It preserves nearly all the benefits of laparoscopic colectomy reported in the literature. With experience, it is associated with significantly reduced operative times. Wider adoption of hand-assisted laparoscopic colorectal surgery would increase the number of patients benefiting from minimal access colorectal surgery.” |
| Published: | December 2007 - Journal Surgical American College of Surgeons |
| Excerpt: | “For complex colectomies, HALS substantially reduced operative time and conversion rate, with the same complication rate. HALS increased the number of MACs [minimal access colectomies] performed. More notably, HALS was used preferentially for complex colectomies. HALS effectively bridges the complexity divide between minimal access and open procedures. HALS may serve as a technology to expand MAC.” |
| Published: | March 2024 - Surgery |
| Excerpt: | “The challenges of colectomy for diverticulitis-associated fistulas can be mitigated using the hand-assisted laparoscopic surgery technique. We found a low conversion-to-open rate, falling below rates reported for laparoscopic colectomy.” |
| Published: | June 2014 - Surgical Laparoscopy, Endoscopy & Percutaneous Techniques |
| Excerpt: | “HALC [hand-assisted laparoscopic colectomy] and open colectomy had similar operating time. HALC was associated with a significantly shorter hospital stay compared with open colectomy (5 vs. 8 d, P=0.001). HALC proved to be technically feasible and safe in this setting. It provided benefits of tactile feedback and manual manipulation as in open colectomy while maintaining the advantages of a minimal invasive approach.” |
| Published: | March 2013 - Journal of Gastrointestinal Surgery |
| Excerpt: | “Conversion to open surgery was less often necessary in HALS compared to lap[aproscopic] cases (3.5 % vs. 12.7 %, p = 0.014). Length of stay, operative time, morbidity and mortality rates were comparable between the two groups. In obese patients who require colectomy, the HALS approach increases the likelihood of a successful minimally invasive operation. At the cost of a clinically negligible increase in incision length, HALS may save a high-risk group conversion to formal laparotomy and the adverse outcomes related to this.” |
| Published: | October 2013 - Surgery Current Research |
| Excerpt: | “During the course of the study, HALC was noted to be an excellent platform to overcome many of the limitations in exposure and positioning by using the surgeon’s hand as a large retractor. The odds ratio of conversion to HALC was 14 for MO [morbidly obese] compared to NW [normal weight] patients. In the subset of converted patients to HALC, no significant difference was observed in the LOS [length of stay] or complication rate. Similar results have been observed in other studies involving a mixed population in which those converted to HALC recovered in a similar fashion to those who did not; whereas those converted to open fared poorly.” |
| Published: | August 2017 - Annals of Coloproctology |
| Excerpt: | “Hand-assisted laparoscopic surgery (HALS) is a minimally invasive surgical technique with the combined benefits of laparoscopic surgery while allowing the use of the surgeon’s hand for better tactile control. Obesity has been associated with higher conversion rates with multiport laparoscopic surgery, but not with HALS. HALS is a versatile, minimally invasive technique, which is independent of the patient’s BMI, for performing a colorectal resection.” |
| Published: | May 2007 - Surgical endoscopy |
| Excerpt: | “The findings suggest that hand-assisted laparoscopic oncologic segmental colonic resection is associated with shorter operative times, more lymph nodes harvested, and equivalent hospital stays, pedicle lengths, and intraoperative blood losses as compared with the totally laparoscopic approach. The totally laparoscopic technique was completed with a smaller incision. However, this less than 1cm reduction in incision length has doubtful clinical significance.” |
| Published: | August 2010 - Surgery |
| Excerpt: | “Colon and rectal cancer can be resected safely using HALS techniques. Conversion rates are low, complication rates expected, durations of hospital stay shorter and the number of lymph nodes retrieved is high.” |
| Published: | October 2012 - Journal of Surgical Research |
| Excerpt: | “Forty-seven LA [laparoscopic-assisted] patients were matched 1:1 by age and resection with 47 HAL [hand-assisted laparoscopy] patients. Patients in the HAL group had significantly lower blood loss (100 versus 150 cc, P = 0.04), operative times (206 versus 252 min, P = 0.002), and conversion rates (6% versus 38%, P < 0.0005). They also spent fewer days in the intensive care unit (0 versus 1, P = 0.004) and had quicker return of flatus (3 versus 4 d, P = 0.03). HAL resulted in more lymph nodes resected (21 versus 15, P = 0.03) and a more adequate lymph node harvest (98% vs 77%, P = 0.01). HAL is associated with improved operative efficiency, conversion rates and lymphadenectomy as compared with LA colorectal cancer resections. HAL should be considered in the management of colorectal cancer patients.” |
| Published: | March 2021 - Techniques in Minimally Invasive Surgery |
| Excerpt: | “Hand-assisted total abdominal colectomy is the most obvious example of a procedure that if done open would require a long and disfiguring incision and instead can now be done through a small suprapubic mini laparotomy. A hand-assisted approach for total colectomy facilitates colonic mobilization and is associated with a reduction in operative time and rate of conversion to open when compared to straight laparoscopy, with no difference in complication rates or short-term outcomes.” |
| Published: | April 2010 - Surgical Endoscopy |
| Excerpt: | “The findings showed that HALS subtotal and total colectomies are feasible and safe. The HALS procedure currently seems potentially beneficial for patients with extensive Crohn’s colitis by reducing the operative time for laparoscopic surgery while retaining its less invasiveness.” |
| Published: | December 2017 - Journal of Minimal Invasive Surgery |
| Excerpt: | “With HAL [hand-assisted laparoscopy], surgeons can use touch to assist the exploration of tissues and to more easily determine how to proceed. It also allows traction or pushing of tissue with carefully adjusted pressure, blunt dissection between inflamed tissues with minimal injury, and digital vascular control, all of which allow complex laparoscopic operations to be performed more safely and effectively in an emergency. Moreover, the hand port can be used as a mini laparotomy without conversion and without any extension from its initial size. For the experienced surgeon, HAL can be a reasonable option and a good method to expand the indications for laparoscopy to more severe cases, thereby providing the benefits of minimally invasive surgery.” |
| Published: | January 2010 - Colorectal Disease |
| Excerpt: | “In conclusion, we have found that the operative time for HALC decreased as operative experience was gained. For quality-related outcomes, there was no learning curve. Rather, acceptable HALC outcomes were achieved from the outset. Thus, concerns about initial quality-related outcomes should not be a deterrent to surgeons who are considering the adoption of this technique.” |
| Published: | February 2010 - Colorectal Disease |
| Excerpt: | “Hand-assisted laparoscopic colectomy may be associated with a significantly shorter learning curve for TAC [total abdominal colectomy] as results are better than early LC [laparoscopic colectomy] and comparable with LC performed by experienced laparoscopic surgeons.” |
| Published: | 2006 December - Hong Kong Medical Journal |
| Excerpt: | "As the feasibility, safety and adequacy of resection are guaranteed, and the long-term outcomes appear similar to those of open surgery, laparoscopic liver resection can be attempted whenever the necessary expertise is available. However, careful case selection is nevertheless very important. " |
| Published: | July 2011 - Journal of Endourology |
| Excerpt: | "Conclusion: We report the largest meta-analysis of HALS renal surgery to date. When compared with open surgery, HALS allows for a significant decrease in EBL [estimated blood loss] and LOS [length of stay]. Compared with laparoscopic donor nephrectomy, HALS resulted in a significant decrease in blood loss, OR time, and WIT [warm ischemia time]." |
| Published: | June 2011 - Journal of Urology |
| Excerpt: | "Our results have shown that hand assistance provides a safe, minimally invasive laparoscopic procedure. Our complications rates were comparable to those with other standard and hand-assist series, although the spectrum of complications varied. Hand-assisted laparoscopic renal surgery could be a method by which to improve patient access to minimally invasive nephron-sparing surgery." |
| Published: | 2011 February - Journal of Endourology |
| Excerpt: | "Laparoscopic radical nephrectomy is the standard of care for the management of most renal cancers. The hand-assisted approach has bridged the gap between open nephrectomy and a pure laparoscopic approach. Hand-assisted laparoscopic nephrectomy allows tactile feedback, thus shortening the learning curve for some surgeons and allowing more experienced laparoscopists to perform more complex and challenging procedures." |
| Published: | 2010 January - Transplant International |
| Excerpt: | "By multiple regression analysis, minimally invasive hand-assisted technique was shown to be associated with a significantly lower risk of major complications and intraoperative incidents, as well as reduced warm ischemia and operative time. In our opinion, the introduction of hand-assisted technique is probably the most significantly single factor for improved results, although accumulated experience and developments in equipment will contribute. Our experience indicates that learning curves are facilitated by the use of hand-assisted technique." |
| Published: | 2004 September - Journal of Endourology / Endourology Society |
| Excerpt: | "The HAL procedure relies heavily on devices that allow the hand to be introduced into the laparoscopic environment. The GelPort, when evaluated in a porcine model by training laparoscopic urologists, appears to be significantly better than other devices available to date. Further testing with larger cohorts and human clinical trials are required to confirm these findings." |
| Published: | 2002 March - Surgical Endoscopy |
| Excerpt: | "In conclusion, hand assisted laparoscopic nephrectomy in living donor kidney transplantation can be recommended as a technique that increases the confidence of the operating surgeon and the safety margin of the procedure. In addition to its shorter operating time and warm ischemia time, HALS offers particular advantages during trocar placement for the prevention of torsion of the kidney and control of potential bleedings, and in the final hazardous stages of vascular stapling and kidney removal." |
| Published: | April 2011 - Canadian Journal of Surgery |
| Excerpt: |
"We believe that HALS has many technical advantages over the purely laparoscopic technique when dealing with a massive spleen. Compared with standard laparoscopic instruments, the hand allows for greater atraumatic exposure of the spleen. The hand also allows for easy tamponade of any bleeding that may be encountered during dissection, which is often a reason for conversion to open splenectomy and excessive blood loss. The hand eases the technically challenging manipulation of the spleen into a retrieval bag. The hand port also adds little incisional morbidity, as a larger utility port is often required for spleen removal in laparoscopic splenectomy. Conclusion: "When compared with open splenectomy, HALS resulted in a significantly reduced length of stay in hospital. It is a valuable technique to have in the surgeon's armamentarium when treating patients with splenomegaly." |
| Published: | June 2006 - World Journal of Surgery |
| Excerpt: | "Hand-assisted laparoscopic splenectomy is a safe and effective technique for the management of spleens larger than 20 cm. The technique results in shorter hospital stays, and it is a good alternative to open splenectomy when treating patients with massive splenomegaly." |
