title: Hand-Assisted Laparoscopic Approach in Colon Surgery.
abstract: BACKGROUND
  This study sought to compare outcomes of patients who underwent hand-assisted laparoscopic (HAL) colectomy with open and laparoscopic colectomy (LP).
  
  
  METHODS
  The NSQIP databases were used to examine the clinical data of patients who underwent elective colectomy during 2012-2013. Multivariate regression analysis was performed to compare the three surgical approaches.
  
  
  RESULTS
  We sampled a total of 21,090 patients who underwent colectomy. Of these, 7480 (35.5 %) had open colectomy (OC), 8751 (41.5 %) had a laparoscopic colectomy, 2860 (13.6 %) had a HAL colectomy, and 1999 (9.5 %) had an open procedure converted from LC or HAL. Multivariate regression analysis revealed HAL colectomy had a similar mortality (AOR 0.53, P = 0.07) and a lower morbidity (AOR 0.37, P < 0.01) compared to OC. LC had lower mortality (AOR 0.58, P = 0.02) and morbidity (AOR 0.43, P < 0.01) compared to OC. Mortality of patients who underwent HAL was not significantly different from LC (AOR 0.90, P = 0.79); however, morbidity of such patients was significantly higher than for patients who underwent LC (AOR 1.29, P < 0.01).
  
  
  CONCLUSIONS
  HAL colectomy is a safe approach with significant advantages compared to open colectomy. Although the morbidity of patients who underwent HAL is higher than patients who underwent LC, the morbidity rate is still lower than OC.
authors: Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA.
authors: Zhobin
authors: Z
authors: Moghadamyeghaneh
authors: Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA.
authors: Joseph C
authors: JC
authors: Carmichael
authors: Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA.
authors: Steven
authors: S
authors: Mills
authors: Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA.
authors: Alessio
authors: A
authors: Pigazzi
authors: Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA.
authors: Ninh T
authors: NT
authors: Nguyen
authors: Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA. mstamos@uci.edu.
authors: Michael J
authors: MJ
authors: Stamos
mesh_terms: D000368:Aged; D003082:Colectomy; D003108:Colonic Diseases / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D005260:Female; D058733:Hand-Assisted Laparoscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
keywords: Colectomy; Colon surgery; Hand assisted; Laparoscopic surgery