It is clear that TME type methods are associated with a superior outcome compared with less radical or stringent techniques. Furthermore, it has also been well demonstrated that the experience and the training of the surgeon are critical variables in determining outcome in this setting. Laparoscopic and hand-assisted hybrid operations must conform to the same oncologic standards. It is also critical that surgeons embarking on these operations have sufficient minimally invasive experience obtained by performing resections for benign disease and for colon cancers.
Presently, in the majority of patients, it is not possible to perform a laparoscopic distal sphincter-saving rectal resection without making an incision large enough to get a hand inside. Regardless, it seems that the use of hybrid methods and the avoidance of a full laparotomy are associated with, at least, some short-term benefits. The use of handassisted methods in this setting is logical. It is the impression of a growing number of surgeons that the hand-assisted method is easier to learn and is a bit quicker than the standard laparoscopic/open hybrid operation. Confirmation of these impressions awaits the performance of a large prospective randomized trial.
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