title: Hand-assisted versus laparoscopic-assisted colorectal surgery: Practice patterns and clinical outcomes in a minimally-invasive colorectal practice.
abstract: BACKGROUND
  Laparoscopic assisted (LA) colectomy has significant patient benefits but is technically challenging. Hand-assisted laparoscopic surgery (HALS) allows tactile feedback because the surgeon's hand assists in retraction and dissection. This may decrease the technical difficulty and shorten the learning curve associated with performing laparoscopic colectomy. We investigated the patient selection and short-term clinical outcomes of HALS and LA since the introduction of HALS to our minimally invasive colorectal practice.
  
  
  METHODS
  Prospectively collected data on 258 patients undergoing HALS (n = 109) or LA colectomy (n = 149) during a calendar year (2004) were analyzed. Patient and disease characteristics, operative parameters, and perioperative outcomes were compared.
  
  
  RESULTS
  HALS patients were similar to LA patients in age (51 vs. 54 yrs), gender (56 vs. 52% male), body mass index (26 vs. 26 kg/m2), comorbidities (84 vs. 85% with one or more), and diagnosis (83 vs. 80% benign), but differed in incidence of previous surgery (49 vs. 30%; P = 0.008). A significantly greater proportion of HALS patients underwent complex procedures and extensive resections. Conversion rates (15 vs. 11%, P = 0.44), intraoperative complications (4 vs. 1%, P = 0.17), 30-day morbidity (18 vs. 11%, P = 0.12) and surgical reinterventions (2 vs. 1%, P = 0.58) did not differ. Recovery measured by days to flatus was not different [mean (standard deviation) 3(2) vs. 3(2) days, P = 0.26], however HALS patients had longer operative times [276(96) vs. 211(107) minutes P < 0.0001] and 1 day longer stay in hospital [6(3) vs. 5 (3) days, P = 0.0009)].
  
  
  CONCLUSIONS
  Patients undergoing HALS underwent more-complex procedures than LA patients but retained the short-term benefits associated with LA colectomy. HALS facilitates expansion of a minimally invasive colectomy practice to include more challenging procedures while maintaining short-term patient benefits.
authors: Division of General Surgery, SIU School of Medicine, Springfield, II 62794, USA.
authors: Imran
authors: I
authors: Hassan
authors: Y Nancy
authors: YN
authors: You
authors: Robert R
authors: RR
authors: Cima
authors: David W
authors: DW
authors: Larson
authors: Eric J
authors: EJ
authors: Dozois
authors: S A
authors: SA
authors: Barnes
authors: John H
authors: JH
authors: Pemberton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003082:Colectomy / Q000295:instrumentation* / Q000379:methods; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006225:Hand; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D010149:Postoperative Pain / Q000503:physiopathology; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate
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