Hand-assisted versus conventional laparoscopic restorative proctocolectomy for ulcerative colitis

In a few comparative and randomized studies, hand-assisted laparoscopic restorative proctocolectomy (HALS-RP) maintained the advantages of a minimally invasive approach with some potential benefits. However, the role of HALS-RP has not been defined. The aim of this study was to evaluate the effectiveness of HALS-RP compared with a conventional laparoscopic restorative proctocolectomy (LAP-RP) in patients with ulcerative colitis.

A retrospective study was conducted using a prospectively maintained database to compare a consecutive series of 30 patients who underwent HALS-RP from June 2004 to September 2007 with 40 patients who underwent LAP-RP from October 1994 to June 2004 in our institution. Patient characteristics, perioperative parameters, and the surgical outcomes were assessed. Mann-Whitney U and Fisher exact tests were used for statistical analysis.

Both groups were well matched with no differences in sex, body mass index, periods from diagnosis, American Society of Anesthesiologists score, performance status, preoperative blood chemistry or steroid, and cyclosporine usage. The median operative time was significantly shorter for HALS-RP [356 (range: 176 to 590) min] than for LAP-RP [505 (range: 360 to 785) min; P<0.001]. The median length of incision was significantly longer for HALS-RP [8 (range: 7.5 to 8) cm] than for LAP-RP [5.5 (range: 5 to 8) cm]. The estimated blood loss and the length of hospital stay were similar between the 2 groups. The incidence of postoperative complications including anastomotic leakage did not differ between the 2 groups (P=0.437).

HALS-RP significantly reduced the operative time compared with the conventional LAP-RP, while retaining the acceptable morbidity rates and recovery benefits associated with minimally invasive surgery. HALS-RP is likely to replace a conventional laparoscopic approach for this technically challenging procedure.