Hand-Assisted Laparoscopic Colorectal Surgery

Abstract

Laparoscopic technique finds wide application in abdominal surgery for its benefits such as smaller wounds and quicker recovery. Laparoscopic colorectal cancer surgery of a curative intent has become popularised since Fowler and Jacobs demonstrated the first laparoscopic sigmoid colectomy in 1990. A few limitations remain, though, as follows: (1) The loss of tactile feedback together with a two-dimensional image makes it difficult for the operator to determine the extent of tumour infiltration and lymph node metastasis. (2) Costly, specialised equipment and longer operating time mean higher cost to patient. (3) It is technically demanding to the surgeon. The learning curve is steep and it takes about 50 cases for an operator to become familiar with the technique. (4) Late stage tumours cannot be excised laparoscopically. It is not feasible to resect T4 lesions, and conversion is required for most of these cases. (5) Bleeding has been a dreaded case, where conversion has often been necessary. With technical improvement and technological advancement, in particular with the appearance of the ultrasonic dissector, laparoscopic colorectal resection has steadily become another commonly performed complex surgery following laparoscopic cholecystectomy.