Hand assisted laparoscopic surgery tends to decrease operation time and conversion rate compared to conventional laparoscopy for colorectal surgery

In the past open surgery was the only method for resection of the colon or rectum. With the advent of laparoscopy, surgeons began to use a minimally invasive approach with the largest incision being an extraction site where the piece of colon or rectum could be removed.  Laparoscopy is difficult to learn and also takes longer than open surgery. A new technique which is a hybrid of the two called ‘hand-assisted laparoscopic surgery’ uses a special device where the surgeon can use one hand to help with the surgery thus returning tactile sensation. The size of the largest incision is only a little bigger than the ‘extraction’ incision used in the conventional laparoscopic approach. This device is expensive but is thought to give patients the same advantages that they get with the conventional laparoscopic approach compared to open surgery such as decreased length of stay, less pain and quicker return of bowel function. This review found that there are three trials that have compared these methods. It seems that the initial operative plan is changed more often in patients who have conventional laparoscopic surgery compared to hand assisted surgery - they more often end up with a hand assisted or open approach (it is most commonly to the hand assisted approach). There is a need for larger trials that explain the manner in which the trials were conducted. An economic analysis is also needed since the hand assist device is expensive and longer follow up of patients is needed.