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World J Gastroenterol. Dec 7, 2010; 16(45): 5662-5668
Published online Dec 7, 2010. doi: 10.3748/wjg.v16.i45.5662
Controversy of hand-assisted laparoscopic colorectal surgery
Abdul-Wahed Nasir Meshikhes
Abdul-Wahed Nasir Meshikhes, Department of Surgery, King Fahad Specialist Hospital, Dammam 31444, Eastern Province, Saudi Arabia
Author contributions: Meshikhes AWN solely contributed to this paper.
Correspondence to: Dr. Abdul-Wahed Nasir Meshikhes, MB ChB, FRCS, Chairman and Consultant Surgeon, Department of Surgery, King Fahad Specialist Hospital, Dammam 31444, Eastern Province, Saudi Arabia. meshikhes@doctor.com
Telephone: +966-3-8431111 Fax: +966-3-8441019
Received: July 15, 2010
Revised: August 18, 2010
Accepted: August 25, 2010
Published online: December 7, 2010

Laparoscopically assisted colorectal procedures are time-consuming and technically demanding and hence have a long steep learning curve. In the technical demand, surgeons need to handle a long mobile organ, the colon, and have to operate on multiple abdominal quadrants, most of the time with the need to secure multiple mesenteric vessels. Therefore, a new surgical innovation called hand-assisted laparoscopic surgery (HALS) was introduced in the mid 1990s as a useful alternative to totally laparoscopic procedures. This hybrid operation allows the surgeon to introduce the non-dominant hand into the abdominal cavity through a special hand port while maintaining the pneumoperitoneum. A hand in the abdomen can restore the tactile sensation which is usually lacking in laparoscopic procedures. It also improves the eye-to-hand coordination, allows the hand to be used for blunt dissection or retraction and also permits rapid control of unexpected bleeding. All of those factors can contribute tremendously to reducing the operative time. Moreover, this procedure is also considered as a hybrid procedure that combines the advantages of both minimally invasive and conventional open surgery. Nevertheless, the exact role of HALS in colorectal surgery has not been well defined during the advanced totally laparoscopic procedures. This article reviews the current status of hand-assisted laparoscopic colorectal surgery as a minimally invasive procedure in the era of laparoscopic surgery.

Keywords: Colorectal surgery, Laparoscopic assisted colorectal surgery, Hand assisted laparoscopic colorectal surgery