title: Totally intracorporeal laparoscopic colectomy (TILC) is associated with similar surgical outcomes in high and low operative risk patients.
abstract: OBJECTIVE
  Patients undergoing laparoscopic-assisted colectomy with obesity, high American Society of Anesthesiologists (ASA) grade, and left-sided colon tumors are at high risk for operative conversion and complications. We hypothesized that a completely intracorporeal laparoscopic colectomy would be beneficial for high-risk patients compared with healthy, low-risk patients.
  
  
  METHODS
  We conducted a retrospective study of 136 consecutive patients undergoing a standardized totally intracorporeal laparoscopic colectomy for neoplasms from February 2004 to September 2011. Patients were stratified into a high-risk group with 1 or more factors: body mass index >30, ASA grade ≥ 3, and left-sided tumors or a low-risk group with no factors. Variables compared were case frequency during the learning curve, body mass index, estimated blood loss, operative time, conversion, 30-day complications, and length of stay. Comparisons between groups were made by χ2 analysis or t test where appropriate. Data are expressed as median ± SD, odds ratio, and significance defined as P<0.05.
  
  
  RESULTS
  Laparoscopic colectomy was performed in 136 patients with a conversion rate of 4%. There were 86 high-risk patients and 50 low-risk patients. High-risk patients had a significantly (P<0.005) longer operative time (225 ± 66 vs. 186 ± 55 min) but no significant difference in estimated blood loss, conversion rates, learning curve, complications, or length of stay compared with low-risk patients.
  
  
  CONCLUSIONS
  When laparoscopic colectomy is performed totally intracorporeally, surgical outcomes in high-risk patients with obesity, high ASA grade, and left-sided tumors are equally successful to results achieved for low-risk patients that are thin, healthy, with right-sided lesions.
authors.affiliation: University of Pittsburgh Medical Center and Bandaid Surgery, Pittsburgh, PA 15232, USA. tiorio17@gmail.com
authors.forename: Tara
authors.initials: T
authors.lastname: Iorio
authors.forename: David
authors.initials: D
authors.lastname: Blumberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000401:mortality / Q000601:surgery; D016017:Odds Ratio; D061214:Patient Safety / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome