Three randomised controlled trials (RCTs) and four non-RCTs were included in the review (n=571 patients, range 24 to 208). Randomisation and allocation concealment were adequate in three studies. Five studies specified eligibility criteria. Four studies used intention-to-treat analysis. Blinding of patients and care provider was not adequate in any study. Only two studies had blinded outcome assessment. Baseline comparability of groups was adequate in four studies.
Operative time was significantly longer during hand-assisted laparoscopic surgery compared with open surgery (four out of seven studies); the additional median operative time ranged from 13 to 81 minutes. However, there was significantly less intra-operative blood loss (two out of five studies) and a significantly shorter period of analgesia use (two out of three studies). The conversion rate to open surgery in the hand-assisted laparoscopic surgery groups ranged from 0 to 10% (five studies).
Compared with open surgery, hand-assisted laparoscopic surgery was significantly associated with a shorter time to passage of flatus (two out of the four studies), which was on average one day advance. Hospital stay was also significantly shorter in the hand-assisted laparoscopic group (four out of the seven studies), with an average gain that ranged from two to four days.
Postoperative morbidity was significantly lower for hand-assisted laproscopy surgery (one out of seven studies).
The number of lymph nodes in the resection specimen was significantly higher in the hand-assisted laproscopy group (one out of three studies).
Results for other outcomes were also reported.