title: Hand-Assisted Laparoscopic Colectomy Improves Perioperative Outcomes Without Increasing Operative Time Compared to the Open Approach: a National Analysis of 8791 Patients.
abstract: Hand-assisted laparoscopic surgery (HALS) is often used in procedures too complex for completely minimally invasive approaches. However, there are concerns for whether this hybrid approach abrogates perioperative benefits of the completely minimally invasive technique.
  
  
  
  We queried the 2012-2013 National Surgery Quality Improvement Program for adults undergoing elective HALS or open colectomy (OC). After propensity matching, short-term outcomes were compared. Subset analysis was performed for segmental resections. Multivariate analysis was used to determine predictors of utilizing either approach.
  
  
  
  This query included 8791 patients (OC 2707, HALS 6084). Predictors of HALS included male sex (OR 1.17, p = 0.006), increasing BMI (OR 1.01, p = 0.02), benign indication (OR 1.48, p < 0.001), and total abdominal colectomy (OR 10.39, p < 0.001). Younger age, black race, ASA class ≥3, inflammatory bowel disease, and low pelvic anastomosis were predictive of OC (all p < 0.05). HALS demonstrated reduced overall complications (p < 0.001), wound complications (p < 0.001), anastomotic leak (p = 0.014), transfusion (p < 0.001), postoperative ileus (p < 0.001), length of stay (p < 0.001), and readmission (p < 0.001) without increased operative time. For segmental resection, HALS demonstrated reduced overall complications, wound complications, respiratory complications, postoperative ileus, anastomotic leak, transfusion, length of stay, and readmissions (all p < 0.05).
  
  
  
  Compared to OC, HALS demonstrates improved perioperative outcomes without increased operative time.
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA. harold.leraas@duke.edu.
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Leraas
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Cecilia T
authors.initials: CT
authors.lastname: Ong
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 A
authors.initials: MA
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 F
authors.initials: BF
authors.lastname: Gilmore
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: Uttara S
authors.initials: US
authors.lastname: Nag
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
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: John
authors.initials: J
authors.lastname: Migaly
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects*; D006801:Humans; D045823:Ileus / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010359:Patient Readmission / Q000706:statistics & numerical data; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology*; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology
keywords: Colorectal surgery; Hand-assisted laparoscopic surgery; Minimally invasive surgery; Outcomes