Hybrid hand-assisted colectomy for transverse colon cancer: a useful technique for non-expert laparoscopic surgeons.

Abstract

Laparoscopic assisted colectomy (LAC) is commonly performed, but LAC for transverse colon cancer is a complex procedure, even in the hands of experts. In particular, laparoscopic take-down of the splenic and/or the hepatic flexure and dissection of the lymph nodes around the middle colic vessels are extremely complicated maneuvers compared to the complexity of these procedures during open surgery. We herein describe a simple and less-invasive technique for performing hybrid hand-assisted laparoscopic colectomy (hybrid-HALC). This procedure combines the established convenient and safe techniques of open surgery with the less invasive hand-assisted laparoscopic approach. From 2000 to 2007, 22 patients with transverse colon cancer underwent hybrid-HALC at our facility. Short-term outcomes of hybrid-HALC were retrospectively compared with those of LAC over the same period and with those of conventional open surgery as a historical control. The intraoperative and postoperative data indicating the short-term outcomes of the hybrid-HALC group were better than those of conventional open surgery and similar to those of the LAC group; the mean operative time for hybrid-HALC was 40 min shorter than that for LAC. Furthermore, the reduction in the operative time in the hybrid-HALC group was more prominent in the case of non-expert surgeons. We conclude that hybrid-HALC for transverse colon cancer is a feasible, convenient, and less-invasive technique, and that it is a useful alternative, especially for non-expert laparoscopic surgeons.