The role of hand-assisted laparoscopy in the age of single incision laparoscopy: An effective alternative to avoid open conversion in colorectal surgery

Kyung Uk Jung, MD, Seong Hyeon Yun, MD, PhD, Yoon Ah Park, MD, Yong Beom Cho, MD, PhD, Hee Cheol Kim, MD, PhD, Woo Yong Lee, MD, PhD, Ho-Kyung Chun, MD, PhD

Samsung Medical Center

Hand-assisted laparoscopic colectomy has been accepted as an alternative method of traditional open procedure, as well as conventional laparoscopic colectomy. However, it needs an incision for hand and two or more incisions for camera and instruments. In the other hand, there has been continuous effort to make fewer incisions and single incision laparoscopic surgery has rapidly emerged as the preferred surgical approach. If so, is the hand-assisted laparoscopic technique behind the time? We introduce the way to take advantage of it, in the age of single incision laparoscopy, as an effective alternative to avoid open conversion.

Between August 2009 and August 2012, 562 single-incision laparoscopic colectomies were performed by a single surgeon. During this period, 12 cases needed some changes from the initial approach, giving the conversion rate 2.1% (12/562). Among these 12 cases, five cases were converted to hand-assisted laparoscopy. Conversion was completed by lengthening of the original incision for SILS and addition of two incisions for trocars. Since we used custom-made glove port consisted with three trocars, we disassembled it and used each trocars. No additional cost was incurred.

The indications for conversion were thick adhesion to adjacent structures due to previous inflammation in two patients, excessive tumor fixit in two patents, and extraordinary thick mesentery and uncontrolled bleeding due to preexisting liver cirrhosis in another one patient. Four of them were successfully completed without the need for open conversion. One patient with rectosigmoid colon cancer invading bladder was finally opened to avoid vesical trigone injury. The mean operation time of the four patients was 265.0 minutes. The mean estimated blood loss was 587.5 milliliter. The postoperative course was uneventful in except for one patient who had prolonged ileus and wound inflection. The patient discharged on postoperative days 34 after conservative management.

Conversion from single incision to hand-assisted laparoscopy in colorectal surgery is feasible and effective. It adds minimal morbidity while preserving advantages of minimally invasive surgery. It could be considered as an alternative to open conversion in cases of single incision laparoscopic surgery, especially when the conversion to conventional laparoscopy doesn’t seem to be helpful.

Session: Podium Presentation

Program Number: S058

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