title: Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial.
abstract: OBJECTIVE
  This study was designed to compare short-term outcomes after hand-assisted laparoscopic vs. straight laparoscopic colorectal surgery.
  
  
  METHODS
  Eleven surgeons at five centers participated in a prospective, randomized trial of patients undergoing elective laparoscopic sigmoid/left colectomy and total colectomy. The study was powered to detect a 30-minute reduction in operative time between hand-assisted laparoscopic and straight laparoscopic groups.
  
  
  RESULTS
  There were 47 hand-assisted patients (33 sigmoid/left colectomy, 14 total colectomy) and 48 straight laparoscopic patients (33 sigmoid/left colectomy, 15 total colectomy). There were no differences in the patient age, sex, body mass index, previous surgery, diagnosis, and procedures performed between the hand-assisted and straight laparoscopic groups. Resident participation in the procedures was similar for all groups. The mean operative time (in minutes) was significantly less in the hand-assisted laparoscopic group for both the sigmoid colectomy (175 +/- 58 vs. 208 +/- 55; P = 0.021) and total colectomy groups (time to colectomy completion, 127 +/- 31 vs. 184 +/- 72; P = 0.015). There were no apparent differences in the time to return of bowel function, tolerance of diet, length of stay, postoperative pain scores, or narcotic usage between the hand-assisted laparoscopic and straight laparoscopic groups. There was one (2 percent) conversion in the hand-assisted laparoscopic group and six (12.5 percent) in the straight laparoscopic group (P = 0.11). Complications were similar in both groups (hand-assisted, 21 percent vs. straight laparoscopic, 19 percent; P = 0.68).
  
  
  CONCLUSIONS
  In this prospective, randomized study, hand-assisted laparoscopic colorectal surgery resulted in significantly shorter operative times while maintaining similar clinical outcomes as straight laparoscopic techniques for patients undergoing left-sided colectomy and total abdominal colectomy.
authors.affiliation: Department of Colon & Rectal Surgery, Lahey Clinic, 41 Mall Road, Burlington, Massachusetts 01805, USA. peter.w.marcello@lahey.org
authors.forename: Peter W
authors.initials: PW
authors.lastname: Marcello
authors.forename: James W
authors.initials: JW
authors.lastname: Fleshman
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Milsom
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Read
authors.forename: Tracey D
authors.initials: TD
authors.lastname: Arnell
authors.forename: Elisa H
authors.initials: EH
authors.lastname: Birnbaum
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Feingold
authors.forename: Sang W
authors.initials: SW
authors.lastname: Lee
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Mutch
authors.forename: Toyooki
authors.initials: T
authors.lastname: Sonoda
authors.forename: Yan
authors.initials: Y
authors.lastname: Yan
authors.forename: Richard L
authors.initials: RL
authors.lastname: Whelan
mesh_terms: D016009:Chi-Square Distribution; D003082:Colectomy / Q000379:methods; D003107:Colorectal Surgery / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome