Laparoscopic total colectomy: hand-assisted vs standard technique.
BACKGROUND
Although hand-assisted laparoscopic surgery (HALS) has been proposed as an alternative to laparoscopically assisted surgery (LAP), little is known about its role in total colectomy. The objectives of the study were to compare the outcomes in patients undergoing total colectomy via either HALS or LAP and to determine what benefits HALS might have in extensive colorectal procedures.


METHODS
We reviewed the data for 23 patients who underwent total proctocolectomy (TPC) or total abdominal colectomy (TAC) using either a HALS or LAP technique.


RESULTS
There were 12 HALS (five TPC, seven TAC) and 11 LAP (seven TPC, four TAC) for ulcerative colitis (n = 17), familial polyposis (n = 5), and colonic inertia (n = 1). One LAP was converted (9.1%). The operative time was shorter for HALS than for LAP (210 vs 273 min; p = 0.03). Blood loss and incision length were similar. Postoperative recovery and morbidity rates were comparable.


CONCLUSIONS
HALS reduces the operative time but patient morbidity rates and recovery are similar to LAP. HALS may be preferable for extensive colorectal procedures such as TPC and TAC.
Nakajima
K
K
Section of Colon and Rectal Surgery, Department of Surgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021, USA.
Lee
S W
SW
Cocilovo
C
C
Foglia
C
C
Sonoda
T
T
Milsom
J W
JW
D000293:Adolescent; D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods* / Q000706:statistics & numerical data; D003108:Colonic Diseases / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006225:Hand; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D020127:Recovery of Function; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome