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Hand-assisted laparoscopic sigmoid colectomy: helping hand or hindrance?
Y-J Chang1, P W Marcello, L C Rusin
1Department of Colon and Rectal Surgery, Lahey Clinic, 41 Mall Road, Burlington, MA 01805, USA.
Background:
Hand-assisted laparoscopic colectomy has been introduced as an alternative to the standard laparoscopic technique, but it has not yet been established whether it offers the same benefits. Therefore, we compared the outcome of patients undergoing hand-assisted laparoscopic sigmoid resection (HALSR) to that of those undergoing laparoscopic sigmoid resection (LSR).
Methods:
The study population comprised a sequential series of consecutive patients undergoing elective laparoscopic sigmoid/left colectomy. Values are reported as mean (range).
Results:
There were 85 LSR patients and 66 HALSR patients, with no differences in patient demographics or diagnoses. There were slight differences in operative time favoring HALSR (LSR 205 min (90-380) vs HALSR 189 min (120-290); p = 0.07), and the extraction incision was larger in the HALSR group (LSR 6.2 cm (3-25) vs HALSR 8.1 cm (7-12); p < 0.01). There was no difference in time for return of bowel function (LSR 2.8 days (1-15) vs HALSR 2.5 days (1-8); p = 0.31) or length of hospital stay (LSR 5.0 days (2-17) vs HALSR 5.2 days (3-22); p = 0.73). Complications were similar in the two groups (LSR 23% vs HALSR 21%), but there were fewer conversions in the hand-assisted group (HALSR 0% vs LSR 13%; p < 0.01).
Conclusions:
Hand-assisted laparoscopic sigmoid resection yields the same outcomes as standard laparoscopic techniques, but with fewer conversions. Hand-assistance is a helpful innovation that may expand the application of laparoscopic colectomy.
