Surgical Endoscopy

, Volume 22, Issue 3, pp 739–743 | Cite as

Hand-assisted versus laparoscopic-assisted colorectal surgery: Practice patterns and clinical outcomes in a minimally-invasive colorectal practice

  • Imran Hassan
  • Y. Nancy You
  • Robert R. Cima
  • David W. Larson
  • Eric J. Dozois
  • S. A. Barnes
  • John H. Pemberton
Article

Abstract

Introduction

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.

Methods

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.

Results

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)].

Conclusions

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.

Keywords

Colorectal cancer Clinical papers Instrumental Technics Bowel 

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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Imran Hassan
    • 1
    • 2
  • Y. Nancy You
    • 2
  • Robert R. Cima
    • 2
  • David W. Larson
    • 2
  • Eric J. Dozois
    • 2
  • S. A. Barnes
    • 3
  • John H. Pemberton
    • 2
  1. 1.Division of General SurgerySIU School of MedicineSpringfieldUSA
  2. 2.Division of Colon and Rectal SurgeryMayo ClinicRochesterUSA
  3. 3.Section of BiostatisticsMayo ClinicRochesterUSA

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