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Hand-assisted laparoscopic colectomy: is there an advantage over open resections?
Louis Reines1, Heidi Fitzgerald1, Kent W Kercher2, B. Todd Heniford2, Yuri W Novitsky2
1University of Connecticut Health Center, Farmington, CT;2Carolinas Medical Center, Charlotte, NC
Objective: Intrabdominal placement of a hand during hand-assisted laparoscopic colectomy may abrogate the benefits of minimally-invasive techniques. We hypothesized that the hand-assisted approach confers the advantages of minimal access surgery over open colectomy.
Design: Retrospective review
Setting: Tertiary-care hospitals
Patients: Consecutive cohort
Interventions: Hand-assisted and open elective colectomy
Main Outcome Measures: patient demographics, operative time, perioperative complications, operative and total hospital charges, and length of stay
Results: Three hundred-ten O and 61 HA consecutive elective colectomies were identified and reviewed. The groups were similar in age, sex, and body mass index. The mean operative time was longer in the HA group (160 vs 202 minutes, p=0.002). There were no major intraoperative complications in either group and no conversions form HA to O colectomy. Anastomotic leak was discovered in 6 (2%) patients in the O and none in the HA groups. There was no difference in wound infection rates [5 (1.3%) in the O and 2 (3.5%) in the HA groups]. All 7 (2.3%) mortalities occurred in the O group. The length of hospitalization was significantly shorter in the HA group (5.1 vs 11.5 days, p<0.001). Total hospital charges were significantly lower in the HA group (,132 vs ,150, p<0.0001)
Conclusions: Hand-assisted laparoscopic colectomy is a safe alternative to traditional open colonic resections. It may be associated with a decreased postoperative morbidity and mortality. Despite longer operative times, the use of the hand-assisted techniques resulted in a significant reduction of the duration of hospitalization and decreased total hospital charges. Overall, in the elective setting, hand-assisted laparoscopic colectomies appear to maintain the advantages of minimally invasive techniques over open colectomies.
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