title: The rate for the use of hand-assisted laparoscopic methods is directly proportional to body mass index.
abstract: BACKGROUND
  Hand-assisted laparoscopic (HAL) colorectal resection remains controversial. Critics believe HAL methods lead to decreased use of laparoscopically assisted (LA) methods. Proponents believe selective HAL use increases minimally invasive surgery (MIS) use rates. This study assessed general and body mass index (BMI)-specific HAL and LA colorectal resection use by surgeons who embraced both methods.
  
  
  METHODS
  This study retrospectively investigated 1,122 patients who underwent colorectal resection during an 8-year period. Surgical method, type of colorectal resection, BMI, comorbidities, incision length, and short-term outcomes were collected.
  
  
  RESULTS
  The surgical methods included LA (60 %), HAL (25 %), and open (OP 15 %) procedures. The HAL group mean BMI was higher than that of the LA group (P < 0.0001), and the HAL use rate varied directly with BMI. The HAL technique was used for 48 % of the rectal, 36 % of the sigmoid, and 4 % of the right colorectal resections. The incision length was directly proportional to BMI for all the methods. Although the HAL incision lengths were significantly longer than the LA incision lengths for a BMI lower than 40 kg/m(2), there was no difference when the BMI was 40 kg/m(2) or higher. The comorbidities were greater in the HAL group than in the LA sigmoid colorectal resection group (P = 0.001). The mean hospital length of stay (LOS) was similar for the HAL and LA patients but longer for the open surgery patients (P < 0.0001 vs HAL group). The major complications, reoperations, and 30-day mortality rates were low and comparable.
  
  
  CONCLUSIONS
  The HAL methods were used primarily for sigmoid and rectal colorectal resections and for higher BMI patients with more comorbidities. The mean incision length difference between the HAL and LA methods was 3.9 cm, but neither the LOS nor the major postoperative complications differed significantly. Selective use of HAL together with LA methods led to a MIS use rate of 85 % and facilitated MIS for high BMI patients. Together, the methods are complementary and may increase the number of minimally invasive surgeries performed.
authors.affiliation: Department of Colorectal Surgery, St. Luke's Roosevelt Hospital, 25 West 59th Street, Suite 7B, New York, NY, 10019, USA, emyers@chpnet.org.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Myers
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Feingold
authors.forename: Tracey D
authors.initials: TD
authors.lastname: Arnell
authors.forename: Linda
authors.initials: L
authors.lastname: Njoh
authors.forename: Vesna
authors.initials: V
authors.lastname: Cekic
authors.forename: Joon Ho
authors.initials: JH
authors.lastname: Jang
authors.forename: Samer
authors.initials: S
authors.lastname: Naffouje
authors.forename: Richard L
authors.initials: RL
authors.lastname: Whelan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003108:Colonic Diseases / Q000453:epidemiology / Q000601:surgery; D003107:Colorectal Surgery / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality; D012002:Rectal Diseases / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult