Hand Assisted Right Hemi-Colectomy

During laparoscopic right hemicolectomy, the anastomosis can be created intra- or extracorporeally. Laparoscopic colon resection is superior to open surgery in regards to postoperative pain, recovery, and hospital stay. However, there are no standardized techniques, and data on technique-specific outcomes are lacking. Various terms are used for laparoscopic colon surgery in the literature, for example, laparoscopic-assisted colectomy (LAC, usually with extracorporeal anastomosis), hand-assisted colectomy (HAC or HALS), and laparoscopic colectomy with intracorporeal anastomosis (LCIA). Additionally, there are various techniques for mobilization of the mesentery (medial-to-lateral vs. lateral-to-medial) and ligation of the vasculature (extra- vs. intracorporeally). Laparoscopic-assisted colectomy (LAC) with creation of an extracorporeal ileocolonic anastomosis (EA) for right-or extended right colectomies remains the preferred approach in most centers. However, this technique limits the ability to choose an extraction site, which is usually a small midline incision. In addition, problems with intestinal alignment after extraction are known to occur. A completely intracorporeal anastomosis (IA) may reduce the likelihood or intestinal twists and offers the possibility of using any abdominal location for specimen extraction.
The question of whether there is any advantage or disadvantage between these 2 techniques remains unanswered.