Clinical Studies

AAA Repair

Laparoscopic Assisted Aortic Surgery. A Review

Published: 2006 October - The Journal of Cardiovascular Surgery
Authors: Kolvenbach R, Ferrari M, Shifrin EG
Excerpt: "Laparoscopic assisted techniques are a less invasive alternative to open surgery as well as to total laparoscopic techniques. They can be used in the majority of patients permitting even more complex suprarenal procedures with clamping times identical to open surgery but a significantly reduced access trauma. We can anticipate that future developments like staplers will makes this approach even more attractive."
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The Case for Minimally Invasive Surgery in Colorectal Cancer and the Development of a Program for Such Surgery

Published: Texas Heart Institute Journal. 2010; 37(6):678-680.
Authors: Daniel Albo, MD, PhD

"Despite mounting evidence of substantial short-term advantages of MIS over open surgery, MIS remains grossly underused in patients with CRC. Our experience has shown that the development of a program to overcome the impediments to MIS enables a rapid increase in the use of MIS, with substantial benefits to both patients and hospitals.

The advantages for patients and hospitals are outlined above. The advantages for surgeons include higher operative volumes, excellent clinical outcomes, and, most importantly, the chance to do the right thing. Furthermore, the development of a MIS CRC program provides increased educational and research opportunities, enhancing the academic mission and paving the way for exciting new discoveries."

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Utility and Short-Term Outcomes of Hand-Assisted Laparoscopic Colorectal Surgery: A Single Institution Experience in 1103 Patients

Published: September 2011 - Diseases of the Colon & Rectum
Authors: Cima, Robert R. M.D., M.A.; Pendlimari, Rajesh M.B.B.S.; Holubar, Stefan D. M.D.; Pattana-arun, Jirawat M.D.; Larson, David W. M.D.; Dozois, Eric J. M.D.; Wolff, Bruce G. M.D.; Pemberton, John H. M.D.
Excerpt: "Conclusions: 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."
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Hand-Assisted Laparoscopic Colectomy: the Learning Curve is for Operative Speed, Not for Quality

Published: Colorectal Disease, The Association of Coloproctology of Great Britain and Ireland. 2010 January;12:304-9.
Authors: E. Ozturk, A. da Luz Moreira and J. D. Vogel
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."
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Adoption of Laparoscopic Colectomy: Results and Implications of ASCRS Hands-On Course Participation

Published: 2008 September - Surgical Innovation
Authors: Howard M. Ross, MD, FACS, FASCRS; James W. Fleshman, MD, FACS, FASCRS; Clifford L. Simmang, MD, FACS, FASCRS; Peter W. Marcello, MD, FACS, FASCRS
Excerpt: "Cadaver course completion enables rapid integration of laparoscopic colon resection into clinical practice and was highly valued. Experience prior to laparoscopic resection of cancer is modest. Hand-assisted technologies promote technique acquisition."
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Hand-Assisted Laparoscopic vs. Laparoscopic Colorectal Surgery: A Multicenter, Prospective, Randomized Trial

Published: 2008 April - Diseases of the Colon & Rectum
Authors: Peter W. Marcello, James W. Fleshman, Jeffrey W. Milsom, Thomas E. Read, Tracey D. Arnell, Elisa H. Birnbaum, Daniel L. Feingold, Sang W. Lee, Matthew G. Mutch, Toyooki Sonoda, Yan Yan, Richard L. Whelan
Excerpt: "In this prospective, randomized study, hand-assisted laparoscopic colorectal surgery resulted in significantly shorter operative time compared with straight laparoscopic surgery. There were no clinically significant differences in the postoperative outcome with regard to return of bowel function, tolerance of diet, length of stay, postoperative pain scores, or analgesic use. 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."
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The Role of Hand-Assisted Laparoscopy in Expanding Minimally Invasive Surgery for Complex Colectomies

Published: 2008 March - Journal of the American College of Surgeons
Authors: Robert R. Cima, MD, MA, FACS; Jirawat Pattana-arun, MD; David W. Larson, MD, FACS; Eric J. Dozois, MD, FACS; Bruce G. Wolff, MD, FACS; John H. Pemberton, MD, FACS
Excerpt: "HALS increased the number of MACs 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."
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How a Hand-Assist Can Help in Lap Colectomy

Published: 2007 January - Contemporary Surgery
Authors: Robert Cima, MD; John Pemberton, MD
Excerpt: "Our own institutional experience as well as that of others supports the use of HALS as an acceptable approach to left-sided colon resections and anterior resections. We recently reported our initial experience with HALS colectomy, which has grown rapidly since it was first introduced into our practice in early 2004.

In 2003 at the Mayo Clinic, we performed 113 laparoscopic colectomies without any HALS cases. However, in the 18 months after the introduction of HALS, our group performed 187 HALS colectomies. The primary indications for HALS procedures were ulcerative colitis (37%), cancer (20%) and diverticulitis (18%).

Furthermore, 113 of those cases were complex colectomies compromised of total proctocolectomies, subtotal colectomies, ileoanal pouch procedures, and rectal cancer surgeries. An analysis of our HALS colectomies for cancer (N=38) showed 68% were for left sided or rectal cancers. In this subset, no anastomotic leaks were reported and the wound infection rate was 5%.

Overall, we have found HALS to be an extremely useful technique for complex colorectal procedures while maintaining the short-term clinical benefits of laparoscopy."

Hand-Assisted Laparoscopic Sigmoid Colectomy: Helping Hand or Hindrance?

Published: 2005 March - Surgical Endoscopy
Authors: Y.J. Chang, P.W. Marcello, L.C. Rusin, P.L. Roberts, D.J. Schoetz
Excerpt: "The results lend support to most of the prior studies and suggest the hand-assisted approach is a viable alternative and perhaps even superior to standard laparoscopic colectomy. We believe that the introduction of the hand is helpful for most surgeons and not a hindrance to the performance of laparoscopic colectomy."
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A Comparison of Laparoscopically Assisted and Open Colectomy for Colon Cancer

Published: 2004 May - New England Journal of Medicine
Authors: The Clinical Outcomes of Surgical Therapy Study Group
Excerpt: "In this multi-institutional study, the rates of recurrent cancer were similar after laparoscopically assisted colectomy and open colectomy, suggesting that the laparoscopic approach is an acceptable alternative to open surgery for colon cancer."
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Hand-Assisted Laparoscopic Colectomy Techniques

Published: 2003 December - Surgical Innovation
Authors: Rasmy Loungnarath MD, FRCSC; James W. Fleshman MD, FACS, FASCRS
Excerpt: "It has been our experience that the use of HALS permits the expansion of laparoscopic surgery to more complex cases. Furthermore, a decrease in the operative time of 30 to 60 minutes is realized compared with SLS-assisted procedures, with more time being saved on complex cases."
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Liver Resection

A Single-Centre Experience of 40 Laparoscopic Liver Resections

Published: 2006 December - Hong Kong Medical Journal
Authors: CN Tang, KK Tsui, JPY Ha, GPY Yang, MKW Li
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. "
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Comparison of Hand-Assisted Laparoscopy Versus Open and Laparoscopic Techniques in Urology Procedures: A Systematic Review and Meta-analysis

Published: July 2011 - Journal of Endourology
Authors: Jonas Wadström, MD, PhD; Amber L. Martin, BS; Rhonda Estok, RN, BSN; Catherine J. Mercaldi, MPH; and Michael D. Stifelman, MD
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]."
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Complications of Hand-assisted Laparoscopic Renal Surgery: Single-Center Ten-year Experience

Published: June 2011 - Journal of Urology
Authors: Moore NW, Nakada SY, Hedican SP, Moon TD
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."
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Hand-Assisted Laparoscopic Radical Nephrectomy

Published: 2011 February - Journal of Endourology
Authors: Sutchin R. Patel, MD; Stephen Y. Nakada, MD
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."
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Minimally Invasive Living Donor Nephrectomy - Introduction of Hand Assistance

Published: 2010 January - Transplant International
Authors: Geir Mjoen, Hallvard Holdaas, Per Pfeffer, Pål-Dag Line and Ole Oyen
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."
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Hand Assisted Laparoscopic Devices: The Second Generation

Published: 2004 September - Journal of Endourology / Endourology Society
Authors: Rupa Patel, MD; Michael D. Stifelman, MD
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."
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HALS for Live Donor Nephrectomy is More Time- and Cost-Effective than Standard Laparoscopic Nephrectomy

Published: 2002 March - Surgical Endoscopy
Authors: P. Lindström, J. Wadström, M. Häggman
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."
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Hand-Assisted Laparoscopic Splenectomy Versus Open Splenectomy for Massive Splenomegaly: 20-Year Experience at a Canadian Centre

Published: April 2011 - Canadian Journal of Surgery
Authors: Todd W. Swanson, MD; Adam T Meneghetti, MD, MHSc; Sharadh Sampath, MD; Joseph M. Connors, MD; O. Neely M. Panton, MD

"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."

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Hand-Assisted Laparoscopic Surgery with a Pfannenstiel Incision in b-Thalassemia Patients: Initial Experience

Published: June 2006 - World Journal of Surgery
Authors: Emmanuel Leandros, MD; Nicholas Alexakis, MD; Konstadinos Albanopoulos, MD; Dimitris Dardamanis, MD; Markisia Karagiorga, MD; Ilias Gomatos, MD; Stefanos Papadopoulos, MD; Christos Bacoyiannis, MD; John Bramis, MD
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."
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