TY - JOUR
T1 - Hand-assisted laparoscopic vs. laparoscopic colorectal surgery
T2 - A multicenter, prospective, randomized trial
AU - Marcello, Peter W.
AU - Fleshman, James W.
AU - Milsom, Jeffrey W.
AU - Read, Thomas E.
AU - Arnell, Tracey D.
AU - Birnbaum, Elisa H.
AU - Feingold, Daniel L.
AU - Lee, Sang W.
AU - Mutch, Matthew G.
AU - Sonoda, Toyooki
AU - Yan, Yan
AU - Whelan, Richard L.
PY - 2008/6
Y1 - 2008/6
N2 - 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.
AB - 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.
KW - Colon cancer
KW - Diverticulitis
KW - Hand assist
KW - Hand assisted colecotmy
KW - Laparoscopic colectomy
KW - Laparoscopic sigmoid colectomy
KW - Laparoscopic total colectomy
KW - Laparoscopy
KW - Ulcerative colitis
UR - http://www.scopus.com/inward/record.url?scp=44749091903&partnerID=8YFLogxK
U2 - 10.1007/s10350-008-9269-5
DO - 10.1007/s10350-008-9269-5
M3 - Article
C2 - 18418653
AN - SCOPUS:44749091903
SN - 0012-3706
VL - 51
SP - 818
EP - 828
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
IS - 6
ER -