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Hand-Assisted Laparoscopic vs. Laparoscopic Colorectal Surgery: A Multicenter, Prospective, Randomized Trial

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Diseases of the Colon & Rectum

Abstract

Purpose

This study was designed to compare short-term outcomes after hand-assisted laparoscopic vs. straight laparoscopic colorectal surgery.

Methods

Eleven surgeons at five centers participated in a prospective, randomized trial of patients undergoing elective laparoscopic sigmoid/left colectomy and total colectomy. The study was powered to detect a 30-minute reduction in operative time between hand-assisted laparoscopic and straight laparoscopic groups.

Results

There were 47 hand-assisted patients (33 sigmoid/left colectomy, 14 total colectomy) and 48 straight laparoscopic patients (33 sigmoid/left colectomy, 15 total colectomy). There were no differences in the patient age, sex, body mass index, previous surgery, diagnosis, and procedures performed between the hand-assisted and straight laparoscopic groups. Resident participation in the procedures was similar for all groups. The mean operative time (in minutes) was significantly less in the hand-assisted laparoscopic group for both the sigmoid colectomy (175 ± 58 vs. 208 ± 55; P = 0.021) and total colectomy groups (time to colectomy completion, 127 ± 31 vs. 184 ± 72; P = 0.015). There were no apparent differences in the time to return of bowel function, tolerance of diet, length of stay, postoperative pain scores, or narcotic usage between the hand-assisted laparoscopic and straight laparoscopic groups. There was one (2 percent) conversion in the hand-assisted laparoscopic group and six (12.5 percent) in the straight laparoscopic group (P = 0.11). Complications were similar in both groups (hand-assisted, 21 percent vs. straight laparoscopic, 19 percent; P = 0.68).

Conclusions

In this prospective, randomized study, hand-assisted laparoscopic colorectal surgery resulted in significantly shorter operative times while maintaining similar clinical outcomes as straight laparoscopic techniques for patients undergoing left-sided colectomy and total abdominal colectomy.

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References

  1. Anonymous. Hand-assisted laparoscopic surgery vs standard laparoscopic surgery for colorectal disease: a prospective randomized trial. HALS Study Group. Surg Endosc 2000;14:896–901.

    Article  Google Scholar 

  2. Vithiananthan S, Cooper Z, Betten K, et al. Hybrid laparoscopic flexure takedown and open procedure for rectal resection is associated with significantly shorter length of stay than equivalent open resection. Dis Colon Rectum 2001;44:927–35.

    Article  PubMed  CAS  Google Scholar 

  3. Targarona EM, Gracia E, Garriga J, et al. Prospective randomized trial comparing conventional laparoscopic colectomy with hand-assisted laparoscopic colectomy: applicability, immediate clinical outcome, inflammatory response, and cost. Surg Endosc 2002;16:234–9.

    Article  PubMed  CAS  Google Scholar 

  4. Cobb WS, Lokey JS, Schwab DP, et al. Hand-assisted laparoscopic colectomy: a single-institution experience. Am Surg 2003;69:578–80.

    PubMed  Google Scholar 

  5. Nakajima K, Lee SW, Cocilovo C, et al. Hand-assisted laparoscopic colorectal surgery using GelPort: initial experience with a new hand device. Surg Endosc 2004;18:102–5.

    Article  PubMed  CAS  Google Scholar 

  6. Nakajima K, Lee SW, Cocilovo C, Foglia C, Sonoda T, Milsom JW. Laparoscopic total colectomy: hand-assisted vs standard technique. Surg Endosc 2004;18:582–6.

    Article  PubMed  CAS  Google Scholar 

  7. Rivadeneira DE, Marcello PW, Roberts PL, et al. Benefits of hand-assisted laparoscopic restorative proctocolectomy: a comparative study. Dis Colon Rectum 2004;47:1371–6.

    Article  PubMed  Google Scholar 

  8. Maartense S, Dunker MS, Slors JF, et al. Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial. Ann Surg 2004;240:984–91.

    Article  PubMed  Google Scholar 

  9. Ballantyne GH, Leahy PF. Hand-assisted laparoscopic colectomy: evolution to a clinically useful technique. Dis Colon Rectum 2004;47:753–65.

    Article  PubMed  Google Scholar 

  10. Kang JC, Chung MH, Chao PC, et al. Hand-assisted laparoscopic colectomy vs open colectomy: a prospective randomized study. Surg Endosc 2004;18:577–81.

    Article  PubMed  Google Scholar 

  11. Chang YJ, Marcello PW, Rusin LC, Roberts PL, Schoetz DJ. Hand-assisted laparoscopic sigmoid colectomy: helping hand or hindrance? Surg Endosc 2005;19:656–61.

    Article  PubMed  Google Scholar 

  12. Wilhelm TJ, Refeidi A, Palma P, Neufang T, Post S. Hand-assisted laparoscopic sigmoid resection for diverticular disease: 100 consecutive cases. Surg Endosc 2006;20:477–81.

    Article  PubMed  CAS  Google Scholar 

  13. Schadde E, Smith D, Alkoraishi AS, Begos DG. Hand-assisted laparoscopic colorectal surgery (HALS) at a community hospital. Surg Endosc 2006;20:1077–82.

    Article  PubMed  CAS  Google Scholar 

  14. Lee SW, Yoo J, Dujovny N, et al. Laparoscopic vs. hand-assisted laparoscopic sigmoidectomy for diverticulitis. Dis Colon Rectum 2006;49:464–9.

    Article  PubMed  Google Scholar 

  15. Zhang LY. Hand-assisted laparoscopic vs. open total colectomy in treating slow transit constipation. Tech Coloproctol 2006;10:152–3.

    PubMed  CAS  Google Scholar 

  16. Boushey R, Marcello PW, Martel G, et al. Laparoscopic total colectomy: an evolutionary experience. Dis Colon Rectum 2007;50:1512–19.

    Google Scholar 

  17. Milsom J, Bohm B, Nakajima. Laparoscopic colorectal surgery. New York: Springer-Verlag, 2006.

    Google Scholar 

  18. DeMets DL, Lan KK. Interim analysis: the alpha spending function approach. Stat Med 1994;13:1341–52.

    Article  PubMed  CAS  Google Scholar 

  19. O’Brien PC, Fleming TR. A multiple testing procedure for clinical trials. Biometrics 1979;35:549–56.

    Article  PubMed  CAS  Google Scholar 

  20. Senn S. Some controversies in planning and analysing multi-centre trials. Stat Med 1998;17:1753–65.

    Article  PubMed  CAS  Google Scholar 

  21. Marcello PW, Milsom JW, Wong SK, et al. Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy. Dis Colon Rectum 2000;43:604–8.

    Article  PubMed  CAS  Google Scholar 

  22. Ky AJ, Sonoda T, Milsom JW. One-stage laparoscopic restorative proctocolectomy: an alternative to the conventional approach? Dis Colon Rectum 2002;45:207–10.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Colon & Rectal Surgery, Lahey Clinic, 41 Mall Road, Burlington, Massachusetts, 01805, USA

    Peter W. Marcello M.D.

  2. Department of Colon & Rectal Surgery, Washington University in St. Louis, St. Louis, Missouri, USA

    James W. Fleshman M.D., Elisa H. Birnbaum M.D. & Matthew G. Mutch M.D.

  3. Department of Surgery, New York Presbyterian Hospital, Weill-Cornell Medical College, New York, New York, USA

    Jeffrey W. Milsom M.D., Sang W. Lee M.D. & Toyooki Sonoda M.D.

  4. Division of Colon & Rectal Surgery, Western Pennsylvania Hospital, Pittsburgh, Pennsylvania, USA

    Thomas E. Read M.D.

  5. Department of Surgery, New York Presbyterian Hospital, Columbia Presbyterian School of Medicine, New York, New York, USA

    Tracey D. Arnell M.D., Daniel L. Feingold M.D. & Richard L. Whelan M.D.

  6. Department of Surgery & Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA

    Yan Yan Ph.D.

Authors
  1. Peter W. Marcello M.D.
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  2. James W. Fleshman M.D.
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  3. Jeffrey W. Milsom M.D.
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  4. Thomas E. Read M.D.
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  5. Tracey D. Arnell M.D.
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  6. Elisa H. Birnbaum M.D.
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  7. Daniel L. Feingold M.D.
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  8. Sang W. Lee M.D.
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  9. Matthew G. Mutch M.D.
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  10. Toyooki Sonoda M.D.
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  11. Yan Yan Ph.D.
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  12. Richard L. Whelan M.D.
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Corresponding author

Correspondence to Peter W. Marcello M.D..

Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.

Reprints are not available

Drs. Marcello, Read, and Mutch are consultants for Applied Medical and have received honoraria and potential stock options. Drs. Milsom and Whelan have received honoraria for speaking on behalf of Applied Medical. Applied Medical provided financial support to the institutions for the project.

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Marcello, P.W., Fleshman, J.W., Milsom, J.W. et al. Hand-Assisted Laparoscopic vs. Laparoscopic Colorectal Surgery: A Multicenter, Prospective, Randomized Trial. Dis Colon Rectum 51, 818–828 (2008). https://doi.org/10.1007/s10350-008-9269-5

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  • DOI: https://doi.org/10.1007/s10350-008-9269-5

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