Hand-assisted laparoscopic colorectal surgery.

The use of laparoscopic techniques in the treatment of colorectal diseases was first described in the early 1990s. Even though its clinical benefits have been well documented, laparoscopic colorectal surgery has been slow to gain adoption in the surgical community, given its technical demands. To help overcome these challenges while preserving the clinical benefits derived from a minimally invasive approach, hand-assisted laparoscopic surgery (HALS) was proposed. HALS can decrease the learning curve by restoring tactile sensation and improving proprioception, and it may be more accessible for surgeons already in practice. A meta-analysis of the 3 published RCTs comparing hand-assisted laparoscopic to conventional laparoscopic colorectal resection showed a significantly lower rate of conversion in the hand-assist patients, while morbidity rates were equivalent. The meta-analysis further indicated that short-term postoperative benefits of conventional laparoscopic colectomies were preserved and costs were likely to be offset by reduced operative time and specific need of laparoscopic equipment. HALS represents a valuable option for performing colorectal resections.