Abstract：
OBJECTIVE: Hand-assisted laparoscopic surgery (HALS) is an alternative to straight laparoscopy (LAP) in colorectal surgery. Many studies have compared the two in terms of efficacy, complications, and outcomes. This meta-analysis aims to uncover if there are any significant differences in conversion rates, operative times, body mass index (BMI), incision lengths, intraoperative and postoperative complications, and length of stay.
METHODS: Comprehensive searches were performed on databases from their respective inceptions to 16 December 2021, with a manual search performed through Scopus. Randomized controlled trials (RCTs), cohort studies, and case series involving more than 10 patients were included.
RESULTS: A total of 47 studies were found fitting the inclusion criteria, with 5 RCTs, 41 cohort studies, and 1 case series. Hand-assisted laparoscopic surgery was associated with lower conversion rates (odds ratio [OR] 0.41, 95%CI 0.28-0.60, p < 0.00001), shorter operative times (Mean Difference [MD] - 8.32 min, 95%CI - 14.05- - 2.59, p = 0.004), and higher BMI (MD 0.79, 95%CI 0.46-1.13, p < 0.00001), but it was also associated with longer incision lengths (MD 2.19 cm, 95%CI 1.66-2.73 cm, p < 0.00001), and higher postoperative complication rates (OR 1.15, 95%CI 1.06-1.24, p = 0.0004). Length of stay was not different in HALS as compared to Lap (MD 0.16 days, 95%CI - 0.06-0.38 days, p = 0.16, and intraoperative complications were the same between both techniques.
CONCLUSIONS: Hand-assisted laparoscopy is a suitable alternative to straight laparoscopy with benefits and risks. While there are many cohort studies comparing HALS and LAP, more RCTs would be needed for a better quality of evidence.
METHODS: Comprehensive searches were performed on databases from their respective inceptions to 16 December 2021, with a manual search performed through Scopus. Randomized controlled trials (RCTs), cohort studies, and case series involving more than 10 patients were included.
RESULTS: A total of 47 studies were found fitting the inclusion criteria, with 5 RCTs, 41 cohort studies, and 1 case series. Hand-assisted laparoscopic surgery was associated with lower conversion rates (odds ratio [OR] 0.41, 95%CI 0.28-0.60, p < 0.00001), shorter operative times (Mean Difference [MD] - 8.32 min, 95%CI - 14.05- - 2.59, p = 0.004), and higher BMI (MD 0.79, 95%CI 0.46-1.13, p < 0.00001), but it was also associated with longer incision lengths (MD 2.19 cm, 95%CI 1.66-2.73 cm, p < 0.00001), and higher postoperative complication rates (OR 1.15, 95%CI 1.06-1.24, p = 0.0004). Length of stay was not different in HALS as compared to Lap (MD 0.16 days, 95%CI - 0.06-0.38 days, p = 0.16, and intraoperative complications were the same between both techniques.
CONCLUSIONS: Hand-assisted laparoscopy is a suitable alternative to straight laparoscopy with benefits and risks. While there are many cohort studies comparing HALS and LAP, more RCTs would be needed for a better quality of evidence.
摘要：
目的：在结直肠手术中，手助腹腔镜手术（HALS）是直腹腔镜（LAP）的替代方法。许多研究在疗效方面对两者进行了比较，并发症,和结果。这项荟萃分析旨在发现转化率是否有任何显著差异，手术时间，体重指数（BMI），切口长度,术中和术后并发症，和逗留时间的长短。
方法：从各自开始到2021年12月16日，对数据库进行了全面搜索，并通过Scopus进行了手动搜索。随机对照试验（RCT），队列研究，包括超过10名患者的病例系列。
结果：共发现47项研究符合纳入标准，有5个RCT，41项队列研究，和1个案例系列。手助腹腔镜手术与较低的转换率相关(比值比[OR]0.41,95CI0.28-0.60,p<0.00001),手术时间较短(平均差异[MD]-8.32分钟，95CI-14.05--2.59，p=0.004），和更高的BMI（MD0.79，95CI0.46-1.13，p<0.00001），但它也与较长的切口长度（MD2.19厘米，95CI1.66-2.73厘米,p<0.00001),术后并发症发生率较高（OR1.15，95CI1.06-1.24，p=0.0004）。与Lap相比，HALS的住院时间没有差异（MD0.16天，95CI-0.06-0.38天，p=0.16，两种技术的术中并发症相同。
结论：手助腹腔镜是直式腹腔镜的合适替代方案，具有益处和风险。虽然有许多队列研究比较了HALS和LAP，为了获得更好的证据质量，需要更多的随机对照试验。
方法：从各自开始到2021年12月16日，对数据库进行了全面搜索，并通过Scopus进行了手动搜索。随机对照试验（RCT），队列研究，包括超过10名患者的病例系列。
结果：共发现47项研究符合纳入标准，有5个RCT，41项队列研究，和1个案例系列。手助腹腔镜手术与较低的转换率相关(比值比[OR]0.41,95CI0.28-0.60,p<0.00001),手术时间较短(平均差异[MD]-8.32分钟，95CI-14.05--2.59，p=0.004），和更高的BMI（MD0.79，95CI0.46-1.13，p<0.00001），但它也与较长的切口长度（MD2.19厘米，95CI1.66-2.73厘米,p<0.00001),术后并发症发生率较高（OR1.15，95CI1.06-1.24，p=0.0004）。与Lap相比，HALS的住院时间没有差异（MD0.16天，95CI-0.06-0.38天，p=0.16，两种技术的术中并发症相同。
结论：手助腹腔镜是直式腹腔镜的合适替代方案，具有益处和风险。虽然有许多队列研究比较了HALS和LAP，为了获得更好的证据质量，需要更多的随机对照试验。
