The role of hand assist laparoscopic surgery (HALS) in pelvic surgery for nonmalignant disease

OBJECTIVE: Hand assist laparoscopic surgery (HALS) is a surgical modality rarely used in benign gynecology. We analyzed nonmalignant pelvic disorders that utilized HALS to see whether there is any benefit over standard laparotomy. METHODS: A case control chart review identified patients who underwent HALS for a variety of benign gynecological conditions from 2004 through 2007. Cases were then compared with a control group of all the patients who underwent similar procedures for the same diagnosis via laparotomy (ELAP) in our center within the same time period. The groups were comparable with respect to age, BMI, and surgical indication. RESULTS: Twenty-nine patients were analyzed: 12 cases (HALS) and 17 controls (ELAP). Each group was broken up into 2 subsets: Group A, older patients who underwent surgery for pelvic organ prolapse or diverticulitis with adnexectomy and Group B, younger patients who underwent surgery for pelvic pain, endometriosis, or both. Hospital stay in Group B was statistically lower in the HALS cases vs. the ELAP controls, (2.9 vs. 5.4 days, P=0.04). All HALS and ELAP patients were then analyzed for overall trends. HALS cases had shorter hospitalization than ELAP controls had (3.3 vs 4.5 days, P=0.035). Estimated blood loss was also less overall in the HALS cases vs. the ELAP controls (175 vs 355.9 mL, P=0.021). There were 2 adverse outcomes reported in Group A of the HALS cases. These 2 patients experienced postoperative hernias though the hand-assist port-site incision. CONCLUSION: Compared with laparotomy, overall, HALS offers the advantage of decreased hospitalization and decreased intraoperative blood loss. Postoperative hernias through the HA port site may be a potential problem with this technique.