Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial.

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.

• Authors: Peter W Marcello, James W Fleshman, Jeffrey W Milsom, Thomas E Read, Tracey D Arnell, Elisa H Birnbaum, Daniel L Feingold, Sang W Lee, Matthew G Mutch, Toyooki Sonoda, Yan Yan, Richard L Whelan
• Journal: Diseases of the colon and rectum (Dis Colon Rectum) Vol. 51 Issue 6 Pg. 818-26; discussion 826-8 (Jun 2008) ISSN: 1530-0358 [Electronic] United States
• PMID: 18418653 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Topics

• Chi-Square Distribution
• Colectomy (methods)
• Colorectal Surgery (methods)
• Female
• Humans
• Laparoscopy (methods)
• Male
• Middle Aged
• Pain Measurement
• Postoperative Complications
• Prospective Studies
• Statistics, Nonparametric
• Treatment Outcome