Surgeons who support "pure" laparoscopic surgery use the service access essentially to remove the surgical specimen or for extra-body anastomosis, but the very need to perform this incision led to the development of instruments through which the surgeon could insert a hand into the patient's abdomen, while maintaining the pneumoperitoneum. These instruments (hand-ports) allow an incision a few centimetres long that can be located in the hypogastrium and therefore it is also aesthetically acceptable for the patient. They enhance both the efficacy of laparoscopy and the tactile sensitivity offered by the hand inserted in the abdomen.
This approach, which utilizes the hand-port, is called hand-assisted laparoscopy (HAL). With a sufficiently large protected access, it is possible to comfortably remove the specimen but most of all to insert a hand in the abdomen with the possibility of restoring tactile sense, of dislocating the intestine with a less traumatic traction than that of any laparoscopic instrument, thus obtaining better colon exposure. Even haemostasis in the case of a bleeding colic vessel can be easily conducted, reducing the blood loss and/or the need for conversion.
In comparing the conventional laparoscopic technique (VDLA) [32, 36] with HAL, results seem markedly superior in the latter case above all in terms of reduced operating time and consequently total costs, without reducing the known advantages of the laparoscopic approach compared to the traditional open approach . Moreover, the learning curve for HAL appears to be shorter because technical gestures are more similar to the traditional ones. In FAP patients, contraindications are minimal and are generally related to the presence of desmoid tumours, mostly intra-abdominal ones, or to the presence of colic or rectal cancer, at least in our experience.
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