Hand-assisted versus laparoscopic-assisted colorectal surgery: Practice patterns and clinical outcomes in a minimally-invasive colorectal practice
- Imran HassanAffiliated withDivision of General Surgery, SIU School of MedicineDivision of Colon and Rectal Surgery, Mayo Clinic
- , Y. Nancy YouAffiliated withDivision of Colon and Rectal Surgery, Mayo Clinic
- , Robert R. CimaAffiliated withDivision of Colon and Rectal Surgery, Mayo Clinic Email author
- , David W. LarsonAffiliated withDivision of Colon and Rectal Surgery, Mayo Clinic
- , Eric J. DozoisAffiliated withDivision of Colon and Rectal Surgery, Mayo Clinic
- , S. A. BarnesAffiliated withSection of Biostatistics, Mayo Clinic
- , John H. PembertonAffiliated withDivision of Colon and Rectal Surgery, Mayo Clinic
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Laparoscopic assisted (LA) colectomy has significant patient benefits but is technically challenging. Hand-assisted laparoscopic surgery (HALS) allows tactile feedback because the surgeon’s hand assists in retraction and dissection. This may decrease the technical difficulty and shorten the learning curve associated with performing laparoscopic colectomy. We investigated the patient selection and short-term clinical outcomes of HALS and LA since the introduction of HALS to our minimally invasive colorectal practice.
Prospectively collected data on 258 patients undergoing HALS (n = 109) or LA colectomy (n = 149) during a calendar year (2004) were analyzed. Patient and disease characteristics, operative parameters, and perioperative outcomes were compared.
HALS patients were similar to LA patients in age (51 vs. 54 yrs), gender (56 vs. 52% male), body mass index (26 vs. 26 kg/m2), comorbidities (84 vs. 85% with one or more), and diagnosis (83 vs. 80% benign), but differed in incidence of previous surgery (49 vs. 30%; P = 0.008). A significantly greater proportion of HALS patients underwent complex procedures and extensive resections. Conversion rates (15 vs. 11%, P = 0.44), intraoperative complications (4 vs. 1%, P = 0.17), 30-day morbidity (18 vs. 11%, P = 0.12) and surgical reinterventions (2 vs. 1%, P = 0.58) did not differ. Recovery measured by days to flatus was not different [mean (standard deviation) 3(2) vs. 3(2) days, P = 0.26], however HALS patients had longer operative times [276(96) vs. 211(107) minutes P < 0.0001] and 1 day longer stay in hospital [6(3) vs. 5 (3) days, P = 0.0009)].
Patients undergoing HALS underwent more-complex procedures than LA patients but retained the short-term benefits associated with LA colectomy. HALS facilitates expansion of a minimally invasive colectomy practice to include more challenging procedures while maintaining short-term patient benefits.
KeywordsColorectal cancer Clinical papers Instrumental Technics Bowel
- Hand-assisted versus laparoscopic-assisted colorectal surgery: Practice patterns and clinical outcomes in a minimally-invasive colorectal practice
Volume 22, Issue 3 , pp 739-743
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- Colorectal cancer
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- Author Affiliations
- 1. Division of General Surgery, SIU School of Medicine, Springfield, II 62794, USA
- 2. Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, 55905, USA
- 3. Section of Biostatistics, Mayo Clinic, Rochester, MN, 55905, USA