title: Hand-assisted laparoscopic restorative proctocolectomy for ulcerative colitis.
abstract: OBJECTIVE
  To evaluate the utility of hand-assisted laparoscopic restorative proctocolectomy (HALS-RP) compared with the conventional open procedure (OPEN-RP).
  
  
  METHODS
  Fifty-one patients who underwent restorative total proctocolectomy with rectal mucosectomy and ileal pouch anal anastomosis between January 2008 and July 2015 were retrospectively analyzed. Twenty-three patients in the HALS-RP group and twenty-four patients in the OPEN-RP group were compared. Four patients who had purely laparoscopic surgery were excluded. Restorative total proctocolectomy was performed with mucosectomy and a hand-sewn ileal-pouch-anal anastomosis. Preoperative comorbidities, intraoperative factors such as blood loss and operative time, postoperative complications, and postoperative course were compared between two groups.
  
  
  RESULTS
  Patients in both groups were matched with regards to patient age, gender, and American Society of Anesthesiologists score. There were no significant differences in extent of colitis, indications for surgery, preoperative comorbidities, and preoperative medications in the two groups. The median operative time for the HALS-RP group was 369 (320-420) min, slightly longer than the OPEN-RP group at 355 (318-421) min; this was not statistically significant. Blood loss was significantly less in HALS-RP [300 (230-402) mL] compared to OPEN-RP [512 (401-1162) mL, P = 0.003]. Anastomotic leakage was noted in 3 patients in the HALS-RP group and 2 patients in the OPEN-RP group (13% vs 8.3%, NS). The rates of other postoperative complications and the length of hospital stay were not different between the two groups.
  
  
  CONCLUSIONS
  HALS-RP can be performed with less blood loss and smaller skin incisions. This procedure is a feasible technique for total proctocolectomy for ulcerative colitis.
authors.affiliation: Norimitsu Shimada, Hiroki Ohge, Raita Yano, Naoki Murao, Norifumi Shigemoto, Shinnosuke Uegami, Yusuke Watadani, Kenichiro Uemura, Yoshiaki Murakami, Taijiro Sueda, Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 734-8551, Japan.
authors.forename: Norimitsu
authors.initials: N
authors.lastname: Shimada
authors.affiliation: Norimitsu Shimada, Hiroki Ohge, Raita Yano, Naoki Murao, Norifumi Shigemoto, Shinnosuke Uegami, Yusuke Watadani, Kenichiro Uemura, Yoshiaki Murakami, Taijiro Sueda, Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 734-8551, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ohge
authors.affiliation: Norimitsu Shimada, Hiroki Ohge, Raita Yano, Naoki Murao, Norifumi Shigemoto, Shinnosuke Uegami, Yusuke Watadani, Kenichiro Uemura, Yoshiaki Murakami, Taijiro Sueda, Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 734-8551, Japan.
authors.forename: Raita
authors.initials: R
authors.lastname: Yano
authors.affiliation: Norimitsu Shimada, Hiroki Ohge, Raita Yano, Naoki Murao, Norifumi Shigemoto, Shinnosuke Uegami, Yusuke Watadani, Kenichiro Uemura, Yoshiaki Murakami, Taijiro Sueda, Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 734-8551, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Murao
authors.affiliation: Norimitsu Shimada, Hiroki Ohge, Raita Yano, Naoki Murao, Norifumi Shigemoto, Shinnosuke Uegami, Yusuke Watadani, Kenichiro Uemura, Yoshiaki Murakami, Taijiro Sueda, Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 734-8551, Japan.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Shigemoto
authors.affiliation: Norimitsu Shimada, Hiroki Ohge, Raita Yano, Naoki Murao, Norifumi Shigemoto, Shinnosuke Uegami, Yusuke Watadani, Kenichiro Uemura, Yoshiaki Murakami, Taijiro Sueda, Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 734-8551, Japan.
authors.forename: Shinnosuke
authors.initials: S
authors.lastname: Uegami
authors.affiliation: Norimitsu Shimada, Hiroki Ohge, Raita Yano, Naoki Murao, Norifumi Shigemoto, Shinnosuke Uegami, Yusuke Watadani, Kenichiro Uemura, Yoshiaki Murakami, Taijiro Sueda, Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 734-8551, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watadani
authors.affiliation: Norimitsu Shimada, Hiroki Ohge, Raita Yano, Naoki Murao, Norifumi Shigemoto, Shinnosuke Uegami, Yusuke Watadani, Kenichiro Uemura, Yoshiaki Murakami, Taijiro Sueda, Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 734-8551, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Uemura
authors.affiliation: Norimitsu Shimada, Hiroki Ohge, Raita Yano, Naoki Murao, Norifumi Shigemoto, Shinnosuke Uegami, Yusuke Watadani, Kenichiro Uemura, Yoshiaki Murakami, Taijiro Sueda, Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 734-8551, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Murakami
authors.affiliation: Norimitsu Shimada, Hiroki Ohge, Raita Yano, Naoki Murao, Norifumi Shigemoto, Shinnosuke Uegami, Yusuke Watadani, Kenichiro Uemura, Yoshiaki Murakami, Taijiro Sueda, Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 734-8551, Japan.
authors.forename: Taijiro
authors.initials: T
authors.lastname: Sueda
keywords: Hand-assisted laparoscopic surgery; Laparoscopic surgery; Proctocolectomy; Ulcerative colitis