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

Area of Science:

• Minimally Invasive Surgery
• Colorectal Surgery
• Surgical Technology

Background:

• Laparoscopic colorectal surgery offers benefits over open procedures.
• Hand-assisted laparoscopy (HAL) is an alternative to conventional straight laparoscopy (SL).
• Comparative data on HAL versus SL for colorectal procedures are limited.

Purpose of the Study:

• To compare short-term outcomes of hand-assisted laparoscopic versus straight laparoscopic colorectal surgery.
• To evaluate operative time, patient recovery, and complication rates.
• To assess the efficacy of HAL in elective sigmoid/left colectomy and total colectomy.

Main Methods:

• Prospective, randomized trial involving 11 surgeons at 5 centers.
• Patients underwent elective laparoscopic sigmoid/left colectomy or total colectomy.
• Study powered to detect a 30-minute operative time difference between HAL and SL groups.

Main Results:

• Mean operative time was significantly shorter in the HAL group for both sigmoid colectomy (175 vs. 208 minutes) and total colectomy (127 vs. 184 minutes).
• No significant differences observed in return of bowel function, diet tolerance, length of stay, pain, or narcotic use.
• Conversion rates (2% vs. 12.5%) and complication rates (21% vs. 19%) were similar between HAL and SL groups.

Conclusions:

• Hand-assisted laparoscopic colorectal surgery demonstrates significantly shorter operative times compared to straight laparoscopic techniques.
• HAL maintains comparable clinical outcomes to SL for left-sided and total colectomies.
• HAL is a safe and effective alternative for specific colorectal procedures.