title: Hand-Assisted Laparoscopic Versus Standard Laparoscopic Colectomy: Are Outcomes and Operative Time Different?
abstract: HAL colectomy is a technique perceived to provide the benefits of laparoscopic surgery while improving tactile feedback and operative time. Published data are largely limited to small, single-institution studies.
  
  
  
  The 2012-2013 National Surgical Quality Improvement Program Participant Data Use File was queried for patients undergoing elective SL or HAL colectomy. Patients underwent 1:1 propensity matching and had outcomes compared. An additional subgroup analysis was performed for patients undergoing segmental resections only.
  
  
  
  13,949 patients were identified, of whom 6084 (43.6 %) underwent HAL colectomy. Patients undergoing HAL versus SL colectomy had higher rates of postoperative ileus (8.7 vs. 6.3 %, p < 0.001), wound complication (8.8 vs. 6.8 %, p = 0.006), and 30-day readmission (7.5 vs. 6.0 %, p = 0.002), without any differences in operative time (156 vs. 157 min, p = 0.713). Amongst segmental colectomies, HAL remained associated with higher rates of wound complications (8.6 vs. 6.5 %, p = 0.016), postoperative ileus (8.9 vs. 6.3 %, p < 0.001), and 30-day readmission (7.1 vs. 5.9 %, p = 0.041) with no difference in operative time between HAL and SL (145 vs. 145 min, p = 0.334).
  
  
  
  Use of HAL colectomy is associated with increased risk of wound complications, postoperative ileus, and readmissions. Importantly, this technique is not associated with any decrease in operative time.
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA. brian.gilmore@duke.edu.
authors.forename: Brian F
authors.initials: BF
authors.lastname: Gilmore
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Zhifei
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Adam
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Jina
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Ezekian
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Ong
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: John
authors.initials: J
authors.lastname: Migaly
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mantyh
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D016208:Databases, Factual / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Colorectal surgery; Hand-assisted laparoscopic surgery; Minimally invasive surgery; Outcomes