Hand-Assisted Laparoscopic Colectomy May Be a Second Revolutionary Surgery after Laparoscopic Cholecystectomy

The aim of this prospective study was to determine the benefit of Hand-Assisted Laparoscopic Colectomy (HALC) for the patients compared to conventional open colectomy (OC). Laparoscopic surgery is popular for good cosmetics, less pain, rapid recovery and short hospital stay. However it is still in controversy because of longer operative time, larger expense and higher technical demand. Only laparoscopic cholecystectomy is unconditionally accepted and used worldwide nowadays. It has been outstanding for "Surgery of Revolution" in the past decade. We believe that HALC will be another operation for such a title in the near future. Because it not only maintains the advantages of minimal invasive surgery but regains the fundamental role of open surgery such as tactile sensation, manipulation and hemostasis. The patients with resectable colorectal cancers were randomized into two arms: 19 consecutive patients on Open and 25 patients on HALC arms according to the day of admission. The patient`s clinical data, operative time, conversion rate, complications, early and long term results were analyzed prospectively. The characteristics of the patients in both groups were quite similar. The pain scores, number of analgesic injection, time to ambulation, time to oral intake, wound infection and length of stay were favorable of HALC group especially in the elderly. The operative time was 60-90 min longer for HALC group without increasing complication. Local recurrence and survival were also similar or superior to the OC group. We proved that HALC was associated with favorable recovery and adequate oncological clearance. It can be safely performed with superior quality of life outcomes in comparison with OC. We believe that HALC would be a standard procedure or at least a widely used laparoscopic technique for treatment of colorectal cancer.