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Related Experiment Videos

Laparoscopic total colectomy: an evolutionary experience.

Robin P Boushey1, Peter W Marcello, Guillaume Martel

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

Diseases of the Colon and Rectum
|September 1, 2007
PubMed
Summary
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Hand-assisted laparoscopic surgery reduces conversions for challenging colectomies. This technique offers a safe alternative, especially for surgeons with less laparoscopic experience, improving procedural outcomes.

Area of Science:

  • Minimally invasive surgery
  • Colorectal surgery
  • Surgical techniques

Background:

  • Laparoscopic total abdominal colectomy and proctocolectomy are complex procedures.
  • Advancements in minimally invasive tools, like hand-assist devices, may impact surgical performance.
  • Comparing hand-assisted versus straight laparoscopic approaches is crucial for optimizing these operations.

Purpose of the Study:

  • To evaluate the outcomes of laparoscopic total colectomy.
  • To compare the hand-assisted laparoscopic approach with the straight laparoscopic technique for these procedures.

Main Methods:

  • A prospective database of 130 patients undergoing hand-assisted or straight laparoscopic total abdominal colectomy/proctocolectomy from 1997-2004 was analyzed.
  • Four colorectal surgeons, three with limited laparoscopic experience, performed the procedures.

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  • Patient characteristics, perioperative parameters, and outcomes were assessed.

    • Main Results:

    • Hand assistance led to significantly fewer conversions to open surgery (2.2% vs. 7.1%, P < 0.01).
    • No conversions occurred in the total abdominal colectomy group with hand assistance (0% vs. 9.6%, P = 0.05).
    • A trend towards reduced operative time was observed with hand assistance, and more cases were performed by non-laparoscopic staff surgeons (22.2% vs. 10.6%, P < 0.05).

    Conclusions:

    • Laparoscopic total colectomy is a feasible and safe surgical option.
    • The hand-assisted technique demonstrates a significant reduction in conversions and facilitates procedures by less experienced surgeons.
    • Hand-assisted laparoscopy represents a valuable alternative to straight laparoscopy for technically demanding colectomies.