Hand-assisted versus laparoscopic-assisted colorectal surgery: Practice patterns and clinical outcomes in a minimally-invasive colorectal practice.
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.
Hassan
Imran
I
Division of General Surgery, SIU School of Medicine, Springfield, II 62794, USA.
You
Y Nancy
YN
Cima
Robert R
RR
Larson
David W
DW
Dozois
Eric J
EJ
Barnes
S A
SA
Pemberton
John H
JH
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
J Am Coll Surg. 2007 Feb;204(2):291-307
17254934
Dis Colon Rectum. 2004 May;47(5):753-65
15073660
Ann Surg. 2004 Dec;240(6):984-91; discussion 991-2
15570204
Surg Endosc. 2004 Apr;18(4):577-81
15026923
Surg Endosc. 2007 Feb;21(2):234-7
17160652
Dis Colon Rectum. 2006 Apr;49(4):464-9
16518715
Surg Endosc. 2006 Jul;20(7):1077-82
16736305
Surg Endosc. 2004 Apr;18(4):582-6
15026921
Surg Endosc. 2004 Jan;18(1):102-5
12958676
Surg Endosc. 2005 May;19(5):656-61
15776212
J Gastrointest Surg. 2006 Dec;10(10):1330-6; discussion 1336-7
17175451
Ann Surg. 2006 May;243(5):667-70; discussion 670-2
16633002
Surg Endosc. 2000 Oct;14(10):896-901
11080399
Surg Endosc. 2001 Nov;15(11):1277-81
11727133
Surg Endosc. 2000 Oct;14(10):891-5
11080398
Surg Endosc. 2004 Mar;18(3):397-401
14735341
Surg Endosc. 2000 Nov;14(11):999-1004
11116405
Dis Colon Rectum. 2005 Oct;48(10):1845-50
16175324
Dis Colon Rectum. 2005 May;48(5):975-81
15793638
Ann Surg. 2000 May;231(5):715-23
10767793