Laparoscopic total colectomy: an evolutionary experience.
OBJECTIVE
Laparoscopic total abdominal colectomy and total proctocolectomy are technically challenging operations. Advances in minimally invasive techniques, including sleeveless hand-assist devices, may influence performance of these procedures. This study was designed to evaluate the results of laparoscopic total colectomy and to compare the hand-assisted approach with straight laparoscopy.


METHODS
Sequential patients undergoing hand-assisted and straight laparoscopic total abdominal colectomy and total proctocolectomy from 1997 to 2004 were identified from a single institution prospective database involving four colorectal surgeons, of which three had limited laparoscopic experience. Patient characteristics, perioperative parameters, and outcomes were assessed.


RESULTS
A total of 130 patients were analyzed. Sixty-nine patients underwent total abdominal colectomy (hand-assisted 17 vs. straight laparoscopic 52), and 61 underwent total proctocolectomy (hand-assisted 28 vs. straight laparoscopic 33). For both total abdominal colectomy and total proctocolectomy, the hand-assisted and straight laparoscopic groups were well matched. Although no differences were observed in operative blood loss and intraoperative complications, hand assistance resulted in fewer overall conversions to open (1/45 (2.2 percent) vs. 6/85 (7.1 percent); P < 0.01), with no conversions in the total abdominal colectomy group (0 vs. 9.6 percent; P = 0.05). There was a trend toward reduced operative time with hand assistance, and nonlaparoscopic staff surgeons performed a greater proportion of the hand-assisted cases (22.2 vs. 10.6 percent; P < 0.05).


CONCLUSIONS
Laparoscopic total colectomy is technically feasible and safe. With a significant reduction in conversions and a greater proportion of cases performed by nonlaparoscopic surgeons, there was an evolutionary shift to a hand-assisted technique. A hand-assisted approach may be a useful alternative to a straight laparoscopic approach for this technically challenging operation.
Boushey
Robin P
RP
Department of Colon and Rectal Surgery, Lahey Clinic, 41 Mall Road, Burlington, Massachusetts 01805, USA.
Marcello
Peter W
PW
Martel
Guillaume
G
Rusin
Lawrence C
LC
Roberts
Patricia L
PL
Schoetz
David J
DJ
D000328:Adult; D015331:Cohort Studies; D003082:Colectomy / Q000295:instrumentation / Q000379:methods*; D003108:Colonic Diseases / Q000601:surgery*; D016208:Databases, Factual; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome