Abstract
Background
The recent introduction of hand-assist devices in laparoscopic colorectal surgery has renewed interest in the influence of incision length. This study aimed to define the impact of extraction incision length on the postoperative outcomes of laparoscopic left-sided colon and rectal resections.
Methods
Consecutive patients undergoing laparoscopic left-sided colorectal resection from 1991 to 2007 were retrieved from a prospectively collected database. The association between incision length and patient characteristics, diagnosis, and perioperative outcomes were analyzed using logistic regression, Spearman correlation, Wilcoxon test, and chi-square test.
Results
A total of 494 laparoscopic colorectal resections (left, sigmoid, anterior, and low anterior resections) were retrieved. Patients with conversions to open surgery (n = 59) and missing data (n = 53) were excluded. As a result, 382 cases were included in the study. A slight majority of the patients had malignant disease (n = 202, 53%). The median incision length was 5 cm (interquartile range, 4–6 cm). Increasing weight was positively correlated with incision length (p = 0.0001). Male patients had modestly larger mean incisions than female patients (5.5 vs. 5.0 cm; p = 0.0075). Age, previous surgery, diagnosis, days to resumption of normal diet, and days to discharge from hospital showed no significant relationship with incision length. No association was observed between the incision length and intraoperative or postoperative complications.
Conclusions
Patients undergoing laparoscopic colorectal surgery appear to achieve the same perioperative outcomes irrespective of their extraction incision lengths. To maintain the short-term benefits of laparoscopy, surgeons should consider pursuing a minimally invasive technique, even when a larger extraction incision will ultimately be required.
Similar content being viewed by others
References
Martel G, Boushey RP (2006) Laparoscopic colon surgery: past, present, and future. Surg Clin North Am 86:867–897
Buunen M, Gholghesaei M, Veldkamp R, Meijer DW, Bonjer HJ, Bouvy ND (2004) Stress response to laparoscopic surgery: a review. Surg Endosc 18:1022–1028
Sylla P, Kirman I, Whelan RL (2005) Immunological advantages of advanced laparoscopy. Surg Clin North Am 85:1–18
Basse L, Jakobsen DH, Bardram L, Billesbølle P, Lund C, Mogensen T, Rosenberg J, Kehlet H (2005) Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study. Ann Surg 241:416–423
Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW (2003) Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 46:851–859
Hsu TC (2005) Feasibility of colectomy with mini-incision. Am J Surg 190:48–50
Ballantyne GH, Leahy PF (2004) Hand-assisted laparoscopic colectomy: evolution to a clinically useful technique. Dis Colon Rectum 47:753–765
Senagore AJ, Delaney CP, Madboulay K, Brady KM, Fazio CVW (2003) Laparoscopic colectomy in obese and nonobese patients. J Gastrointest Surg 7:558–561
Schwandner O, Farke S, Schiedeck TH, Bruch HP (2004) Laparoscopic colorectal surgery in obese and nonobese patients: do differences in body mass indices lead to different outcomes? Surg Endosc 18:1452–1456
Leroy J, Ananian P, Rubino F, Claudon B, Mutter D, Marescaux J (2005) The impact of obesity on technical feasibility and postoperative outcomes of laparoscopic left colectomy. Ann Surg 241:69–76
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM (2005) Short-term end points of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726
Hasegawa H, Kabeshima Y, Watanabe M, Yamamoto S, Kitajima M (2003) Randomized controlled trial of laparoscopic versus open colectomy for advanced colorectal cancer. Surg Endosc 17:636–640
Kaiser AM, Kang JC, Chan LS, Vukasin P, Beart RW Jr (2004) Laparoscopic-assisted vs open colectomy for colon cancer: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 14:329–334
Liang JT, Huang KC, Lai HS, Lee PH, Jeng YM (2007) Oncologic results of laparoscopic versus conventional open surgery for stage II or III left-sided colon cancers: a randomized controlled trial. Ann Surg Oncol 14:109–117
Noel JK, Fahrbach K, Estok R, Cella C, Frame D, Linz H, Cima RR, Dozois EJ, Senagore AJ (2007) Minimally invasive colorectal resection: short-term comparison with open procedures. J Am Coll Surg 204:291–307
Leung KL, Lai PBS, Ho RLK, Meng WCS, Yiu RYC, Lee JFY, Lau WY (2000) Systemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma: a prospective randomized trial. Ann Surg 231:506–511
Stein S, Whelan RL (2007) The controversy regarding hand-assisted colorectal resection. Surg Endosc 21:2123–2126
Tjandra JJ, Chan MKY, Yeh CH (2008) Laparoscopic- vs. hand-assisted ultralow anterior resection: a prospective study. Dis Colon Rectum 51:26–31
Marcello PW, Fleshman JW, Milsom JW, Read TE, Arnell TD, Birnbaum EH, Feingold DL, Lee SW, Mutch MG, Sonoda T, Yan Y, Whelan RL (2008) Hand-assisted laparoscopic vs laparoscopic colorectal surgery: a multicenter, prospective, randomized trial. Dis Colon Rectum 51:818–826
Targarona EM, Gracia E, Garriga J, Martínez-Bru C, Cortés M, Boluda R, Lerma L, Trías M (2002) Prospective randomized trial comparing conventional laparoscopic colectomy with hand-assisted laparoscopic colectomy: applicability, immediate clinical outcome, inflammatory response, and cost. Surg Endosc 16:234–239
Chang YJ, Marcello PW, Rusin LC, Roberts PL, Schoetz DJ (2005) Hand-assisted laparoscopic sigmoid colectomy: helping hand or hindrance? Surg Endosc 19:656–661
Lee SW, Yoo J, Dujovny N, Sonoda T, Milsom JW (2006) Laparoscopic vs hand-assisted laparoscopic sigmoidectomy for diverticulitis. Dis Colon Rectum 49:464–469
Acknowledgment
The Minimally Invasive Surgery Research Group at the Ottawa Hospital is supported by unrestricted educational grants from Covidien Canada and Storz Canada.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bouchard, A., Martel, G., Sabri, E. et al. Impact of incision length on the short-term outcomes of laparoscopic colorectal surgery. Surg Endosc 23, 2314–2320 (2009). https://doi.org/10.1007/s00464-009-0328-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-009-0328-3