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Hand Assisted Laparoscopic Surgery for Colorectal Cancer: Surgical and Oncological Outcomes from a Single Tertiary Referral Centre. J Clin Med 2022; 11:jcm11133781. [PMID: 35807066 PMCID: PMC9267732 DOI: 10.3390/jcm11133781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 02/04/2023] Open
Abstract
The aim of this study was to report overall experience, perioperative and long-term survival results in a single tertiary referral center in Lithuania with hand assisted laparoscopic surgery (HALS) for colorectal cancer. A prospectively maintained database included 467 patients who underwent HALS for left-sided colon and rectal cancer, from April 2006 to October 2016. All those operations were performed by three consultant surgeons and nine surgical residents, in all cases assisted by one of the same consultant surgeons. There were 230 (49.25%) females, with an average age of 64 ± 9.7 years (range, 26–91 years). The procedures performed included 170 (36.4%) anterior rectal resections with partial mesorectal excision, 160 (34.26%) sigmoid colectomies, 81 (17.35%) left hemicolectomies, 45 (9.64%) low anterior rectal resections with total mesorectal excision, and 11 (2.25%) other procedures. Stage I colorectal cancer was found in 140 (29.98%) patients, 139 (29.76%) stage II, 152 (32.55%) stage III and 36 (7.71%) stage IV. There were five conversions to open surgery (1.1%). The mean postoperative hospital stay was 6.9 ± 3.4 days (range, 1–30 days). In total, 33 (7.06%) patients developed postoperative complications. The most common complications were small bowel obstruction (n = 6), anastomotic leakage (n = 5), intraabdominal abscess (n = 4) and dysuria (n = 4). There were two postoperative deaths (0.43%). Overall, 5-year survival for all TNM stages was 85.7%, 93.2% for stage I, 88.5% for stage II and 76.3% for stage III. Hand assisted colorectal surgery for left-sided colon and rectal cancer in a single tertiary referral center was feasible and safe, having all the advantages of minimally invasive surgery, with good perioperative parameters, adequate oncological quality and excellent survival.
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Hamilton AER, Stevenson ARL, Warren CD, Westwood DA. Colorectal surgeons should be open to modern surgical technologies for challenging cases. ANZ J Surg 2018; 88:831-835. [PMID: 30069998 DOI: 10.1111/ans.14741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 01/20/2023]
Abstract
Today, colorectal surgeons globally are practicing in an exciting era where surgical technologies are constantly emerging. Most of these cutting-edge technologies are readily available in Australia and New Zealand at present. Thus the 'modern surgeon' should always be defined by this open-minded attitude towards these new and emerging surgical technologies. This review article highlights current modalities that we have been using in our north-Brisbane public and private hospitals for cases predicted to be technically challenging using minimally invasive approaches for most of them. We examined the current evidence regarding the following modalities and critiqued their use in clinical practice: lighted ureteric stents, minimally invasive surgery approaches of laparoscopy and robotic surgery, pressure barrier insufflation devices, 3D camera systems, hand-assist device ports and indocyanine green dye fluorescence angiography. The objective of this review paper is to alert colorectal surgeons to new surgical technologies available to them, to encourage colorectal surgeons' familiarization with these many technologies, and to support evidence-based consideration for the clinical use of such. These technologies should be supplemental aides to the safe, oncologically adequate and efficient operation that they already routinely perform.
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Affiliation(s)
- Auerilius E R Hamilton
- Department of Colorectal Surgery, Holy Spirit Northside Private Hospital, Brisbane, Queensland, Australia.,Department of Colorectal Surgery, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrew R L Stevenson
- Department of Colorectal Surgery, Holy Spirit Northside Private Hospital, Brisbane, Queensland, Australia.,Department of Colorectal Surgery, The University of Queensland, Brisbane, Queensland, Australia.,Department of Colorectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Conor D Warren
- Department of Colorectal Surgery, Holy Spirit Northside Private Hospital, Brisbane, Queensland, Australia.,Department of Colorectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - David A Westwood
- Department of Colorectal Surgery, Holy Spirit Northside Private Hospital, Brisbane, Queensland, Australia.,Department of Colorectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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3
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Ford DC, Schroeder MC, Ince D, Ernst EJ. Cost-effectiveness analysis of initial treatment strategies for mild-to-moderate Clostridium difficile infection in hospitalized patients. Am J Health Syst Pharm 2018; 75:1110-1121. [DOI: 10.2146/ajhp170554] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Diana C. Ford
- Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Mary C. Schroeder
- Division of Health Services Research, University of Iowa College of Pharmacy, Iowa City, IA
| | - Dilek Ince
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Erika J. Ernst
- Division of Health Services Research, University of Iowa College of Pharmacy, Iowa City, IA
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Hand-assisted Laparoscopy: Expensive but Considerable Step Between Laparoscopic and Open Colectomy. Surg Laparosc Endosc Percutan Tech 2018; 28:214-218. [PMID: 29912135 DOI: 10.1097/sle.0000000000000545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Hand-assisted laparoscopic colectomy (HALC) and laparoscopic-assisted colectomy (LAC) have been shown to have comparable short-term outcomes while there are limited data regarding costs. The aim of our study was to compare the short-term outcomes and costs of HALC and LAC. MATERIALS AND METHODS In total, 46 patients who underwent HALC or LAC for benign or malignant disease between January 2011 and December 2014 at our institution were included in the study. Patients were randomized into HALC or LAC group. Patients' demographics and characteristics, operative details, short-term outcomes, and costs were evaluated. RESULTS There were 25 patients in LAC group and 21 patients in HALC group. Patient's demographics and characteristics and short-term outcomes were comparable between the LAC and HALC groups. Conversion rate was significantly lower in the HALC group (4.7% vs. 28%, P=0.03) while surgical costs ($1706.83±203.70 vs. $1304.93±305.67, P=0.038) and total costs ($2427.18±254.27 vs. $2044.03±215.22, P=0.021) were significantly higher in HALC group. CONCLUSIONS HALC is associated with increased surgical and total hospital costs, and decreased rate of conversion. Although it is more expensive, HALC may be helpful by providing a step between LAC and open surgery before considering conversion.
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Jung KU, Yun SH, Cho YB, Kim HC, Lee WY, Chun HK. The Role of Hand-Assisted Laparoscopic Technique in the Age of Single-Incision Laparoscopy: An Effective Alternative to Avoid Open Conversion in Colorectal Surgery. J Laparoendosc Adv Surg Tech A 2018; 28:415-421. [DOI: 10.1089/lap.2017.0553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Kyung uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University of School of Medicine, Seoul, Republic of Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, Republic of Korea
| | - Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, Republic of Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, Republic of Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, Republic of Korea
| | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University of School of Medicine, Seoul, Republic of Korea
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Overbey DM, Cowan ML, Hosokawa PW, Chapman BC, Vogel JD. Laparoscopic colectomy in obese patients: a comparison of laparoscopic and hand-assisted laparoscopic techniques. Surg Endosc 2017; 31:3912-3921. [PMID: 28281115 DOI: 10.1007/s00464-017-5422-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 01/20/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recent American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP)-based evidence indicates that laparoscopic (LAP) colectomy results in improved outcomes compared to hand-assisted laparoscopic (HAL) colectomy in the general population. Previous comparative studies demonstrated that the HAL technique offers distinct advantages for obese patients. The aim of this study was to perform comparative analyses of HAL and LAP colectomy and low anterior resection (LAR) in obese patients. METHODS The ACS-NSQIP public use file and targeted colectomy dataset, 2012-2014, were utilized for patients undergoing colectomy and LAR. Only obese patients (BMI > 30) and laparoscopic or hand-assisted operations were included. Patient, operation, and outcome variables were compared in two separate cohorts: colectomy and LAR. Bivariate analysis compared the approaches, followed by multivariable regression. RESULTS Of 9610 obese patients included, HAL and LAP colectomy were performed in 3126 and 3793 patients and LAR in 1431 and 1260 patients, respectively. In comparison to LAP colectomy, HAL colectomy patients had increased comorbidities including class 2 and 3 obesity. HAL colectomy was associated with higher overall morbidity (20 vs. 16%, p < 0.001), infectious complications (10.2 vs. 7.7%, p < 0.001), anastomotic leaks (3.0 vs. 2.2%, p = 0.03), and ileus (11 vs. 8%, p < 0.001). Multivariate analysis indicated that overall morbidity (OR 1.27, 95% CI 1.11-1.44), infectious complications (OR 1.35, 95% CI 1.14-1.59), and ileus (OR 1.33, 95% CI 1.12-1.57) were each increased in the HAL colectomy cohort but not different for HAL and LAP LAR. CONCLUSIONS In comparison to LAP colectomy, the HAL technique is used more often in obese patients with an increased operative risk profile. While inherent bias and unmeasured variables limit the analysis, the available data indicate that the HAL technique is associated with increased perioperative morbidity. Alternatively, HAL and LAP LAR are performed in obese patients with a similar risk profile and result in similar postoperative outcomes.
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Affiliation(s)
- Douglas M Overbey
- Department of Surgery, University of Colorado, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA.,Department of Surgery, VA Eastern Colorado HealthCare System, Denver, CO, USA
| | - Michelle L Cowan
- Department of Surgery, University of Colorado, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA.,Department of Surgery, VA Eastern Colorado HealthCare System, Denver, CO, USA
| | - Patrick W Hosokawa
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO, USA
| | - Brandon C Chapman
- Department of Surgery, University of Colorado, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA
| | - Jon D Vogel
- Department of Surgery, University of Colorado, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA.
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Gilmore BF, Sun Z, Adam M, Kim J, Ezekian B, Ong C, Migaly J, Mantyh CR. Hand-Assisted Laparoscopic Versus Standard Laparoscopic Colectomy: Are Outcomes and Operative Time Different? J Gastrointest Surg 2016; 20:1854-1860. [PMID: 27456018 DOI: 10.1007/s11605-016-3206-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/10/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND HAL colectomy is a technique perceived to provide the benefits of laparoscopic surgery while improving tactile feedback and operative time. Published data are largely limited to small, single-institution studies. METHODS The 2012-2013 National Surgical Quality Improvement Program Participant Data Use File was queried for patients undergoing elective SL or HAL colectomy. Patients underwent 1:1 propensity matching and had outcomes compared. An additional subgroup analysis was performed for patients undergoing segmental resections only. RESULTS 13,949 patients were identified, of whom 6084 (43.6 %) underwent HAL colectomy. Patients undergoing HAL versus SL colectomy had higher rates of postoperative ileus (8.7 vs. 6.3 %, p < 0.001), wound complication (8.8 vs. 6.8 %, p = 0.006), and 30-day readmission (7.5 vs. 6.0 %, p = 0.002), without any differences in operative time (156 vs. 157 min, p = 0.713). Amongst segmental colectomies, HAL remained associated with higher rates of wound complications (8.6 vs. 6.5 %, p = 0.016), postoperative ileus (8.9 vs. 6.3 %, p < 0.001), and 30-day readmission (7.1 vs. 5.9 %, p = 0.041) with no difference in operative time between HAL and SL (145 vs. 145 min, p = 0.334). CONCLUSIONS Use of HAL colectomy is associated with increased risk of wound complications, postoperative ileus, and readmissions. Importantly, this technique is not associated with any decrease in operative time.
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Affiliation(s)
- Brian F Gilmore
- Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
| | - Zhifei Sun
- Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA
| | - Mohamed Adam
- Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA
| | - Jina Kim
- Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA
| | - Brian Ezekian
- Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA
| | - Cecilia Ong
- Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA
| | - John Migaly
- Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA
| | - Christopher R Mantyh
- Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA
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Vaccarezza H, Sahovaler A, Im V, Rossi G, Vaccaro C. Hand-assisted laparoscopic colorectal surgery with double-glove technique. SURGICAL PRACTICE 2016. [DOI: 10.1111/1744-1633.12190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hernán Vaccarezza
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
| | - Axel Sahovaler
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
| | - Víctor Im
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
| | - Gustavo Rossi
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
| | - Carlos Vaccaro
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
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Benlice C, Costedio M, Kessler H, Remzi FH, Gorgun E. Comparison of straight vs hand-assisted laparoscopic colectomy: an assessment from the NSQIP procedure-targeted cohort. Am J Surg 2016; 212:406-12. [PMID: 27083065 DOI: 10.1016/j.amjsurg.2016.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/09/2015] [Accepted: 01/03/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The perioperative outcomes of patients who underwent straight laparoscopic (LAP) vs hand-assisted laparoscopic (HALS) surgery were compared using a recently released procedure-targeted database. METHODS The 2012 colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database was used and patients were classified into 2 groups according to the final surgical approach: LAP vs HALS. Demographics, comorbidities, and 30-day outcomes were compared. RESULTS A total of 7,843 patients met the inclusion criteria. There were 4,656 (59%) patients in LAP colectomy and 3,187 (41%) in HALS colectomy groups. Groups were comparable in terms of preoperative characteristics and demographics. Mean operative time was slightly longer in LAP group (178 ± 86 vs 171 ± 84 minutes, P < .001). After covariate-adjustment analysis, the overall morbidity, superficial surgical site infection, and ileus rates remained slightly higher in HALS group. CONCLUSIONS Both straight laparoscopic and hand-assisted approaches are used in colorectal surgery and may complement each other in challenging cases. Implementing the best approach to decrease postoperative complication rates and increase use of minimally invasive techniques may play a role in improving patient care and overall quality.
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Affiliation(s)
- Cigdem Benlice
- Department of Colorectal Surgery, Digestive Disease Institute, 9500 Euclid Avenue, Desk A-30, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Meagan Costedio
- Department of Colorectal Surgery, Digestive Disease Institute, 9500 Euclid Avenue, Desk A-30, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Hermann Kessler
- Department of Colorectal Surgery, Digestive Disease Institute, 9500 Euclid Avenue, Desk A-30, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Feza H Remzi
- Department of Colorectal Surgery, Digestive Disease Institute, 9500 Euclid Avenue, Desk A-30, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease Institute, 9500 Euclid Avenue, Desk A-30, Cleveland Clinic, Cleveland, OH, 44195, USA.
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Gezen FC, Aytac E, Costedio MM, Vogel JD, Gorgun E. Hand-Assisted versus Straight-Laparoscopic versus Open Proctosigmoidectomy for Treatment of Sigmoid and Rectal Cancer: A Case-Matched Study of 100 Patients. Perm J 2016; 19:10-4. [PMID: 25902342 DOI: 10.7812/tpp/14-102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
To assess the efficacy of laparoscopic proctosigmoidectomy for cancer treatment, 25 patients who underwent hand-assisted laparoscopic resection during the study period (9/2006 - 7/2012) were matched to 25 straight-laparoscopic and 50 open-surgery cases. The patients who underwent hand-assisted resection had higher rates of preoperative cardiac disease and hypertension than did the straight-laparoscopy and open-surgery groups. Straight-laparoscopic surgery seems to provide faster convalescence compared with open surgery and hand-assisted laparoscopic surgery.
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Affiliation(s)
- Fazli C Gezen
- Research Fellow in the Digestive Disease Institute Department of Colorectal Surgery at the Cleveland Clinic in OH.
| | - Erman Aytac
- Clinical Research Fellow in the Digestive Disease Institute Department of Colorectal Surgery at the Cleveland Clinic in OH.
| | - Meagan M Costedio
- Colorectal Surgeon in the Digestive Disease Institute Department of Colorectal Surgery at the Cleveland Clinic in OH.
| | - Jon D Vogel
- Associate Professor of Surgery in the Department of Surgery at the University of Colorado School of Medicine in Denver. He was formerly a Colorectal Surgeon in the Digestive Disease Institute Department of Colorectal Surgery at the Cleveland Clinic in OH.
| | - Emre Gorgun
- Colorectal Surgeon in the Digestive Disease Institute Department of Colorectal Surgery at the Cleveland Clinic in OH.
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Silva-Velazco J, Stocchi L, Costedio M, Gorgun E, Kessler H, Remzi FH. Is there anything we can modify among factors associated with morbidity following elective laparoscopic sigmoidectomy for diverticulitis? Surg Endosc 2015; 30:3541-51. [PMID: 26541732 DOI: 10.1007/s00464-015-4651-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/27/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic sigmoidectomy for diverticulitis is widely accepted, using either endolinear staplers or traditional linear staplers under direct vision through the extraction site to transect the rectum. The aim of this study was to assess modifiable factors affecting perioperative morbidity after elective laparoscopic sigmoidectomy for diverticulitis. METHODS Potential associations between perioperative morbidity and demographic, disease-related, and treatment-related factors were assessed on all consecutive patients included in a prospectively collected database undergoing elective laparoscopic sigmoidectomy for diverticulitis between 1992 and 2013. Rectal transection with a linear stapler under direct vision through the extraction site was considered compatible with laparoscopic technique. RESULTS There were two deaths out of 1059 patients (0.19 %). Conversion rate was 13.1 %, overall morbidity 28 %, and anastomotic leak 3.7 %. Independent factors associated with morbidity in an intent-to-treat analysis were ASA 3 (OR 1.53, p = 0.006), conversion (OR 1.71, p = 0.015), and rectal transection without endolinear stapling (traditional linear stapler: OR 1.75, p = 0.003; surgical knife: OR 2.09, p = 0.002). The same factors along with complicated diverticulitis (OR 1.56, p = 0.013) were independently associated with overall morbidity among laparoscopically completed cases. BMI ≥ 35 (OR 2.3, p = 0.017), complicated diverticulitis (OR 2.37, p = 0.002), and rectal transection with a traditional linear stapler (OR 2.19, p = 0.018) were independently associated with abdomino-pelvic infections, both in an intent-to-treat analysis and among laparoscopically completed cases. The number of endolinear stapler firings was not associated with morbidity. CONCLUSIONS Most factors associated with morbidity of laparoscopic sigmoidectomy for diverticulitis cannot be easily modified. With the limitation of a retrospective analysis, modifiable factors to minimize morbidity are laparoscopic completion and endolinear stapling.
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Affiliation(s)
- Jorge Silva-Velazco
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave/A30, Cleveland, OH, 44195, USA
| | - Luca Stocchi
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave/A30, Cleveland, OH, 44195, USA.
| | - Meagan Costedio
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave/A30, Cleveland, OH, 44195, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave/A30, Cleveland, OH, 44195, USA
| | - Hermann Kessler
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave/A30, Cleveland, OH, 44195, USA
| | - Feza H Remzi
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave/A30, Cleveland, OH, 44195, USA
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Endowrist versus wrist: a case-controlled study comparing robotic versus hand-assisted laparoscopic surgery for rectal cancer. Surg Laparosc Endosc Percutan Tech 2015; 24:452-6. [PMID: 25275815 DOI: 10.1097/sle.0b013e318290158d] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic total mesorectal excision (TME) remains a technically challenging procedure. This study aims to compare the surgical outcomes of the robotic-assisted laparoscopic (RAL) versus hand-assisted laparoscopic (HAL) techniques in performing TME for patients with rectal cancers. METHODS A retrospective review of all patients who underwent RAL TME for rectal cancers was performed. These cases were matched for age, sex, and stage of malignancy with patients who underwent HAL TME. Data collected included age, sex, American Society of Anesthesiologists scores, comorbid conditions, types of surgical resections and operative times, perioperative complications, length of hospital stays, and histopathologic outcomes were analyzed. RESULTS From August 2008 to August 2011, 19 patients, with a median age of 62 (range, 47 to 92) years underwent RAL TME. Eight (42.1%) patients received neoadjuvant chemoradiotherapy. The median docking and operative times were 10 (range, 3 to 34) and 390 (range, 289 to 771) minutes, respectively. There was 1 (5.3%) conversion to open surgery. The grade of mesorectal excision was histopathologically reported as complete in all 19 cases. Positive circumferential margin was reported in 1 (5.3%) patient.Comparing the 2 groups, more patients in the RAL group received neoadjuvant chemoradiotherapy (8 vs. 3; P=0.048). The operative times were longer in the RAL group (390 vs. 225 min; P<0.001). A higher proportion of patients in the HAL group required conversion to open surgery (5 vs. 1; P=0.180) and developed perioperative morbidities (3 vs. 7; P=0.269). The median length of hospitalization was comparable between both groups (RAL: 7 vs. HAL: 6 d; P=0.476).The procedural cost was significantly higher in the RAL group (US$12,460 vs. US$8560; P<0.001), whereas the nonprocedural cost remained comparable between the 2 groups (RAL: US$4470 vs. HAL: US$4500; P=0.729). CONCLUSIONS RAL TME is associated with lower conversion and morbidity rates compared with HAL TME. The longer operating times and higher procedural costs are current limitations to its widespread adoption.
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Hand-assisted laparoscopic surgery for left sided colorectal cancer: is quality of surgery related with experience? Eur Surg 2015. [DOI: 10.1007/s10353-015-0341-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Functional and clinical outcomes of hand-assisted laparoscopic colorectal surgery: a single-institution experience in 255 patients. Eur Surg 2015. [DOI: 10.1007/s10353-015-0308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Identification of process measures to reduce postoperative readmission. J Gastrointest Surg 2014; 18:1407-15. [PMID: 24912913 DOI: 10.1007/s11605-013-2429-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 12/02/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Readmission rates after intestinal surgery have been notably high, ranging from 10 % for elective surgery to 21 % for urgent/emergent surgery. Other than adherence to established strategies for decreasing individual postoperative complications, there is little guidance available for providers to work toward reducing their postoperative readmission rates. STUDY DESIGN Processes of care that may affect postoperative readmissions were identified through a systematic literature review, assessment of existing guidelines, and semi-structured interviews with individuals who have expertise in hospital readmissions and surgical quality improvement. Eleven experts ranked potential process measures for validity on the basis of the RAND/University of California, Los Angeles Appropriateness Methodology. RESULTS Of 49 proposed process measures, 34 (69 %) were rated as valid. Of the 34 valid measures, two measures addressed care in the preoperative period. These included evaluation of patient's comorbidities, providing written instruction detailing the anticipated perioperative course, and communication with the patient's referring or primary care doctor. A measure addressing perioperative care stated that institutions should have a standardized perioperative care protocol. Additional measures focused on discharge instructions and communication. CONCLUSIONS An expert panel identified several aspects of care that are considered essential to quality patient care and important to reducing postoperative readmissions.
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Sulu B, Gorgun E, Aytac E, Costedio MM, Kiran RP, Remzi FH. Comparison of hospital costs for single-port and conventional laparoscopic colorectal resection: a case-matched study. Tech Coloproctol 2014; 18:835-9. [DOI: 10.1007/s10151-014-1147-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 03/29/2014] [Indexed: 01/29/2023]
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Samalavicius NE, Gupta RK, Dulskas A, Kazanavicius D, Petrulis K, Lunevicius R. Clinical outcomes of 103 hand-assisted laparoscopic surgeries for left-sided colon and rectal cancer: single institutional review. Ann Coloproctol 2013; 29:225-30. [PMID: 24466536 PMCID: PMC3895545 DOI: 10.3393/ac.2013.29.6.225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 09/23/2013] [Indexed: 12/20/2022] Open
Abstract
Purpose The laparoscopic colectomy is avoided principally because of its technical difficulty, steep learning curve, and increased operative time. Hand-assisted laparoscopic surgery (HALS) is an alternative technique that addresses these problems while preserving the short-term benefits of a laparoscopic colectomy. Our study was aimed to describe the characteristics of patients admitted due to left-sided colon and rectal cancer for HALS. Methods A prospectively maintained database was used to identify patients who underwent HALS at the Institute of Oncology, Vilnius University, from July 1, 2009, to October 1, 2012. Results One hundred-three HALS colorectal resections were performed. The patients' mean age was 64 ± 13.4 years. There were 46 male and 57 female patients. The body mass index was 27.3 ± 5.8 kg/m2. Forty-three patients (41.8%) had experienced prior abdominal surgery. The mean HALS time was 105 minutes (range, 55-85 minutes). The conversion rate was 2.7% (3/103). The median of return of gastrointestinal function was 2.5 days (range, 2.2-4.5 days). The median length of hospital stay was 9 days. The postoperative complication and mortality rates were 10.7% and 0.97%, respectively. Four incisional hernias (3.9%) were seen at a mean follow-up of 7.0 ± 3.4 months. None of the patients had a trocar or a hand-port site recurrence. Conclusion A HALS colorectal resection is a safe and effective technique, and it provides all the benefits of minimally invasive surgery.
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Affiliation(s)
- Narimantas Evaldas Samalavicius
- Center of Oncosurgery, Institute of Oncology, Vilnius University, Clinic of Internal, Family Medicine and Oncology, Faculty of Medicine, Vilnius, Lithuania
| | - Rakesh Kumar Gupta
- Department of Surgery, Gastrointestinal Unit, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Audrius Dulskas
- Vilnius University, Institute of Oncology, Vilnius, Lithuania
| | | | | | - Raimundas Lunevicius
- Aintree University Hospitals NHS Foundation Trust, University Hospital Aintree, Liverpool, UK
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Laparoscopic colorectal surgery for obese patients: decreased conversions with the hand-assisted technique. J Gastrointest Surg 2013. [PMID: 23188222 DOI: 10.1007/s11605-012-2089-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Laparoscopic surgery benefits obese patients but technical difficulties associated with suboptimal exposure and access in these subjects may prompt conversion to open surgery. Hand-assisted laparoscopic surgery (HALS) confers advantages over standard laparoscopy (LAP) by facilitating tactile feedback, assisted dissection, and retraction. These benefits could be particularly valuable in obese patients, allowing completion of difficult laparoscopic procedures in this subgroup. Our aim was to compare intra-operative and post-operative outcomes of HALS and LAP approaches in obese patients undergoing colorectal resection at our institution. METHODS A retrospective study of a prospectively maintained laparoscopic colorectal surgery database was performed. HALS and LAP cases performed in obese patients (body mass index (BMI) >30) were identified and compared for the following outcomes: operative time, intra-operative complications, rate of conversion to open, blood loss, length of stay, post-operative morbidity, and mortality. Outcomes for the converted patients were included on an intention-to-treat basis for all primary analyses. A secondary analysis of nonconverted and converted cases was also performed. RESULTS Over a 5-year period, 496 obese patients underwent laparoscopic colorectal resection; 86 HALS and 410 LAP cases. The two groups were comparable in terms of age, gender, BMI, and indications for surgery. Conversion to open surgery was less often necessary in HALS compared to LAP cases (3.5 % vs. 12.7 %, p = 0.014). The LAP group had a significantly smaller incision length for specimen extraction (HALS (7.0 ± 1.3 cm) vs. LAP (5.7 ± 2.1 cm), p < 0.001). Length of stay, operative time, morbidity, and mortality rates were comparable between the two groups. CONCLUSION In obese patients who require colectomy, the HALS approach increases the likelihood of a successful minimally invasive operation. At the cost of a clinically negligible increase in incision length, HALS may save a high-risk group conversion to formal laparotomy and the adverse outcomes related to this.
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Yang I, Boushey RP, Marcello PW. Hand-assisted laparoscopic colorectal surgery. Tech Coloproctol 2013; 17 Suppl 1:S23-7. [DOI: 10.1007/s10151-012-0933-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 08/20/2012] [Indexed: 02/06/2023]
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Abstract
Laparoscopic colorectal surgery is an accepted alternative to conventional open resection in the surgical approach of both benign and malignant diseases of the colon and rectum. Well-described benefits of laparoscopic surgery include accelerated recovery of bowel function, decreased post-operative pain and shorter hospital stay; these advantages could be particularly beneficial to high-risk patient groups, such as obese patients. At present, data regarding the application of the laparoscopic approach to colorectal resection in the obese is equivocal. We evaluate the available evidence to support laparoscopic colorectal resection in the obese patient population.
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Affiliation(s)
- Sean T Martin
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
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Ng LWC, Tung LM, Cheung HYS, Wong JCH, Chung CC, Li MKW. Hand-assisted laparoscopic versus total laparoscopic right colectomy: a randomized controlled trial. Colorectal Dis 2012; 14:e612-7. [PMID: 22413783 DOI: 10.1111/j.1463-1318.2012.03028.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Laparoscopic colectomy for colorectal cancer is associated with definite short-term benefits, and is increasingly practised worldwide. The limitations of a pure laparoscopic approach include a relative lack of tactile feedback and long procedural time. Hand-assisted laparoscopic surgery was introduced in an attempt to facilitate operation by improving the tactile sensation. To date, there is no consensus as to which approach is better. Herein we conducted a randomized controlled trial comparing hand-assisted laparoscopic colectomy (HALC) with total laparoscopic colectomy (TLC) in the management of right-sided colonic cancer. METHODS Adult patients with carcinoma of the caecum and ascending colon were recruited and randomized to undergo either HALC or TLC. Measured outcomes included operative time, blood loss, conversion rate, postoperative morbidities, postoperative pain, length of hospital stay, disease recurrence and patient survival. RESULTS Sixty patients (HALC=30, TLC=30) were recruited. The two groups were comparable with regard to age, gender distribution, body mass index and final histopathological staging. No difference was observed between the groups in terms of operating time, conversion rate, operative blood loss, pain score and length of hospital stay. With a median follow-up of 27 to 33 months, no difference was observed in terms of disease recurrence, and the 5-year survival rates remained similar (83%vs 80%, P=0.923). CONCLUSION HALC is safe and feasible, but it does not show any significant benefits over TLC in terms of operating time and conversion rate. Routine use of the hand-assisted laparoscopic technique in right hemicolectomy is therefore not recommended.
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Affiliation(s)
- L W C Ng
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan Hong Kong SAR, China.
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Hand-assisted laparoscopic versus open right hemicolectomy: short-term outcomes in a single institution from China. Surg Laparosc Endosc Percutan Tech 2012; 22:267-71. [PMID: 22678326 DOI: 10.1097/sle.0b013e3182516577] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM To compare the perioperative parameters and short-term outcomes of hand-assisted laparoscopic colectomy (HALC) and open colectomy (OC) for the treatment of patients with cancer of the right hemicolon. METHODS Patients who were scheduled to perform right hemicolectomy between August 2009 and December 2010 were randomized into either HALC or OC group. Patients were excluded if they had synchronous cancers, hepatic metastases, acute intestinal obstruction, or intestinal perforations. All the operations in the 2 groups were performed by a single surgical team. Measured outcomes included the demographic variables and perioperative parameters. The former included age, sex, body mass index, American Society of Anesthesiologists class, prior abdominal surgery, distribution of tumors, and histopathologic stage; whereas the latter included length of incision, operative time, estimated blood loss, conversion rate, number of lymph nodes retrieved, postoperative pain score, time to return of bowel function, postoperative complications, duration of hospital stay, and total cost. RESULTS One hundred sixteen patients with cancer of the right hemicolon (HALC=59, OC=57) were recruited. The 2 groups of patients were similar in age, sex distribution, body mass index, American Society of Anesthesiologists class, and previous abdominal surgery. No significant difference was observed between the 2 groups in terms of distribution of tumors and the final histopathologic staging. HALC had a significantly shorter incision length and longer operative time than OC. Patients in the HALC group had significantly less operative blood loss, less pain and earlier passage of flatus after operation than those in the OC group. The number of lymph nodes recovered in the specimen and the overall postoperative complications was comparable in the 2 groups. The postoperative duration of hospital stay was significantly shorter in the HALC group, whereas the median overall costs in the HALC group were significantly higher than that in the OC group. CONCLUSIONS The results from the present study demonstrate that the HALC is a valid surgical approach for cancer of the right hemicolon that retains the benefits of minimally invasive surgery. We believe that this technique is a safe, useful, and feasible method for patients with right-sided colonic cancer. If practiced more, it might be advocated as a "bridge" between traditional laparoscopic surgery and conventional open procedures.
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Liu Z, Wang GY, Chen YG, Jiang Z, Tang QC, Yu L, Muhammad S, Wang XS. Cost Comparison Between Hand-Assisted Laparoscopic Colectomy and Open Colectomy. J Laparoendosc Adv Surg Tech A 2012; 22:209-13. [PMID: 22288882 DOI: 10.1089/lap.2011.0446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Zheng Liu
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Gui-yu Wang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ying-gang Chen
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zheng Jiang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qing-chao Tang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lei Yu
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shan Muhammad
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xi-shan Wang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Fiore JF, Browning L, Bialocerkowski A, Gruen RL, Faragher IG, Denehy L. Hospital discharge criteria following colorectal surgery: a systematic review. Colorectal Dis 2012; 14:270-81. [PMID: 20977587 DOI: 10.1111/j.1463-1318.2010.02477.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to identify and synthesize the hospital discharge criteria that have been used in the colorectal surgery literature. METHODS A systematic literature search was conducted using eight bibliographic databases. Searches were limited to English language journal articles published between January 1996 and October 2009. Primary research applying hospital discharge criteria following colorectal surgery was included. Study selection was made independently by two reviewers. Discharge criteria were extracted from each included study. RESULTS The 156 studies identified by the search strategy described 70 different sets of criteria to indicate readiness for discharge. The majority of studies applied a combination of three or four criteria; those most frequently cited were tolerance of oral intake (80%), return of bowel function (70%), adequate pain control (44%) and adequate mobility (35%). End-points employed to determine the achievement of criteria were generally poorly defined. CONCLUSION A variety of hospital discharge criteria were applied in the colorectal surgery literature. Development of standardized criteria will allow more accurate comparison of results between studies assessing hospital length of stay or other discharge-related outcome measures.
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Affiliation(s)
- J F Fiore
- Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia.
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Geisler D, Garrett T. Single incision laparoscopic colorectal surgery: a single surgeon experience of 102 consecutive cases. Tech Coloproctol 2011; 15:397-401. [PMID: 21887555 DOI: 10.1007/s10151-011-0756-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 07/26/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Due to the recent heightened interest in even less invasive surgery, single port laparoscopic colorectal surgery is quickly gaining acceptance. While this access technique was first described in 2007 for colorectal resective procedures, large series are lacking. METHODS Between January 2009 and October 2010, all patients undergoing single port colorectal surgery performed by a single surgeon were prospectively entered into an IRB-approved database and studied with regard to perioperative events, morbidity, and mortality. RESULTS One hundred and two consecutive patients underwent a single port colorectal procedure. Mean age was 47 years (9-93 years), and average body mass index was 26 kg/m(2) (15-39 kg/m(2)). Primary diagnoses included ulcerative colitis (51), neoplasia (23), Crohn's disease (14), diverticulitis (11), familial adenomatous polyposis (1), and other (2). Procedures included 23 total colectomies, 40 segmental colectomies, and 19 other procedures. There was 1 conversion to an open operation, and 18 (18%) patients required placement of additional ports (1 port: N = 13; 2 ports: N = 2; 3 ports: N = 3). Average operating room time was 99 min (13-245), mean length of incision was 3.7 cm (1.2-7.8 cm), and average estimated blood loss was 140 ml (0-750 ml). There was one postoperative death, and 39 (38%) patients experienced minor postoperative complications. Mean lymph node harvest for oncologic resections was 44 (14-142). The average length of hospital stay was 5.9 days (2-24 days). CONCLUSIONS With proper patient selection and laparoscopic experience, single port colorectal surgery can be performed for even the most complex colorectal procedures. Further studies are needed to assess the benefits that single port colorectal surgery has over a conventional laparoscopic approach.
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Affiliation(s)
- D Geisler
- West Penn Allegheny Health System, Pittsburgh, PA, USA.
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Cima RR, Pendlimari R, Holubar SD, Pattana-Arun J, Larson DW, Dozois EJ, Wolff BG, Pemberton JH. Utility and short-term outcomes of hand-assisted laparoscopic colorectal surgery: a single-institution experience in 1103 patients. Dis Colon Rectum 2011; 54:1076-81. [PMID: 21825886 DOI: 10.1007/dcr.0b013e3182155904] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Despite its introduction in 1991, laparoscopic colectomy is performed in <10% of United States patients requiring colectomy. Laparoscopic colectomy is avoided principally because of its technical difficulty, steep learning curve, and increased operative times. Hand-assisted laparoscopic colectomy is an alternative technique that addresses these problems while preserving the short-term benefits of laparoscopic colectomy. OBJECTIVE To describe the utility and short-term outcomes, we evaluated 1103 patients who underwent hand-assisted laparoscopic colorectal resections over a 5-year period. DESIGN This study was a retrospective analysis of prospectively collected data. SETTINGS The setting was a single tertiary care institution. PATIENTS A total of 1103 consecutive hand-assisted laparoscopic colorectal resections from 2004 to 2009 were identified using a prospectively maintained database. MAIN OUTCOME MEASURES Demographics, perioperative variables, and 30-day outcomes were reported. Data are presented as frequency (proportion) or median (interquartile range). RESULTS A total of 1103 hand-assisted laparoscopic colorectal resections were documented. Median age of patients was 55 years; 47% were women, and median body mass index was 26.5 (range, 23-34) kg/m. Diagnoses included inflammatory bowel disease (35%), colorectal cancer (31%), diverticular disease (23%), and "other" (11%). Forty-two percent of patients had prior abdominal surgery. Segmental colectomies were performed in 533 (48%) patients, proctocolectomy with ileal pouch-anal anastomosis in 229 (21%), proctocolectomy with end ileostomy in 114 (10%), and "other" in 227 (21%). The conversion rate was 9%. Overall median operative time was 201 (range, 145-269) minutes, and the median postoperative length of stay was 5 (range, 4-7) days. Postoperative complications occurred in 27% and readmissions in 7%; mortality was 0.3%. LIMITATIONS This was a single institutional retrospective study. CONCLUSIONS Hand-assisted laparoscopic colorectal resection can be performed for numerous indications. It preserves nearly all the benefits of laparoscopic colectomy reported in the literature. With experience, it is associated with significantly reduced operative times. Wider adoption of hand-assisted laparoscopic colorectal surgery would increase the number of patients benefiting from minimal access colorectal surgery.
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Affiliation(s)
- Robert R Cima
- Division of Colon and Rectal Surgery, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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Papaconstantinou HT, Sharp N, Thomas JS. Single-incision laparoscopic right colectomy: a case-matched comparison with standard laparoscopic and hand-assisted laparoscopic techniques. J Am Coll Surg 2011; 213:72-80; discussion 80-2. [PMID: 21420878 DOI: 10.1016/j.jamcollsurg.2011.02.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 02/10/2011] [Accepted: 02/10/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Single-incision laparoscopic (SIL) colectomy is an advance in minimally invasive colorectal surgical techniques. Feasibility and safety of SIL colectomy has been reported; however, benefits and outcomes are not well-defined. The purpose of this study was to compare outcomes of SIL right colectomy with multiport laparoscopic (LAP) and hand-assisted laparoscopic (HAL) techniques. METHODS SIL right colectomy cases performed between August 2009 and April 2010 were case-matched for age, sex, body mass index, American Society of Anesthesiologists score, previous abdominal surgery, and pathology to an equivalent number of LAP and HAL right colectomy cases. Data analyzed included operative time, procedure conversion, incision length, length of hospital stay, 30-day hospital readmission, surgical site infection and maximum postoperative pain score. RESULTS Twenty-nine patients were analyzed in each of 3 groups (SIL, LAP, and HAL). The mean age (p = 0.96), body mass index (p = 0.48), American Society of Anesthesiologists score (p = 0.74), and rate of previous abdominal operation (p = 0.95) were similar, and sex and pathology were identical among groups. Operative time and conversion rates were similar. The incision length for SIL (4.5 cm) and LAP (5.1 cm) groups was similar, and both were significantly shorter than HAL group (7.2 cm; p < 0.001). Length of hospital stay was 3.4 days for the SIL group and was more than 1-day shorter than LAP and HAL groups (p < 0.05). Postoperative surgical site infection and hospital readmission were similar among groups. Maximum pain score on postoperative days 1 and 2 was significantly lower in SIL group (p < 0.05). CONCLUSIONS SIL right colectomy can improve patient recovery through a decrease in early postoperative pain and shorter length of hospital stay when compared with established laparoscopic techniques.
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Affiliation(s)
- Harry T Papaconstantinou
- Department of Surgery, Section of Colon and Rectal Surgery, Scott & White Memorial Hospital and Clinic, Texas A&M University System Health Science Center College of Medicine, Temple, TX 76508, USA.
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Abstract
As a result of several years of trials and investigations, laparoscopic colectomy for colon cancer is now considered an acceptable and safe alternative to traditional open techniques. Four large randomized trials (Barcelona, COST, COLOR, CLASSIC) have shown the noninferiority of laparoscopic colectomy in overall survival, disease-free survival, and overall and local recurrences. Laparoscopic surgery is associated with better short-term outcomes, such as shorter hospital stay, shorter duration of ileus, less narcotic usefulness and postoperative pain, and a faster postoperative recovery. The procedures are also safe and feasible in elderly patients. Hand-assisted laparoscopic colectomy is a recent hybrid technique that could reduce learning time, and its role has been established in more challenging procedures. Future prospects include robotic and natural-orifice surgery.
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Affiliation(s)
- Gaetano Luglio
- Department of General, Oncological and Minimally-Invasive Surgery--Surgical Coloproctology Unit, Federico II University, Via Pansini 5, Naples, Italy
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Meshikhes AWN. Controversy of hand-assisted laparoscopic colorectal surgery. World J Gastroenterol 2010; 16:5662-8. [PMID: 21128315 PMCID: PMC2997981 DOI: 10.3748/wjg.v16.i45.5662] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 08/18/2010] [Accepted: 08/25/2010] [Indexed: 02/06/2023] Open
Abstract
Laparoscopically assisted colorectal procedures are time-consuming and technically demanding and hence have a long steep learning curve. In the technical demand, surgeons need to handle a long mobile organ, the colon, and have to operate on multiple abdominal quadrants, most of the time with the need to secure multiple mesenteric vessels. Therefore, a new surgical innovation called hand-assisted laparoscopic surgery (HALS) was introduced in the mid 1990s as a useful alternative to totally laparoscopic procedures. This hybrid operation allows the surgeon to introduce the non-dominant hand into the abdominal cavity through a special hand port while maintaining the pneumoperitoneum. A hand in the abdomen can restore the tactile sensation which is usually lacking in laparoscopic procedures. It also improves the eye-to-hand coordination, allows the hand to be used for blunt dissection or retraction and also permits rapid control of unexpected bleeding. All of those factors can contribute tremendously to reducing the operative time. Moreover, this procedure is also considered as a hybrid procedure that combines the advantages of both minimally invasive and conventional open surgery. Nevertheless, the exact role of HALS in colorectal surgery has not been well defined during the advanced totally laparoscopic procedures. This article reviews the current status of hand-assisted laparoscopic colorectal surgery as a minimally invasive procedure in the era of laparoscopic surgery.
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Marshall CL, Chen GJ, Robinson CN, Balentine CJ, Anaya DA, Artinyan A, Awad SS, Berger DH, Albo D. Establishment of a minimally invasive surgery program leads to decreased inpatient cost of care in veterans with colon cancer. Am J Surg 2010; 200:632-5. [DOI: 10.1016/j.amjsurg.2010.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 07/07/2010] [Accepted: 07/07/2010] [Indexed: 10/18/2022]
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Kiran RP, El-Gazzaz GH, Vogel JD, Remzi FH. Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. J Am Coll Surg 2010; 211:232-8. [PMID: 20670861 DOI: 10.1016/j.jamcollsurg.2010.03.028] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 03/31/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND The goal of this study was to compare surgical site infection (SSI) rates between laparoscopic (LAP) and open colorectal surgery using the National Surgical Quality Improvement Program (NSQIP) database. STUDY DESIGN We identified patients included in the NSQIP database from 2006 to 2007 who underwent LAP and open colorectal surgery. SSI rates were compared for the 2 groups. Association between patient demographics, diagnosis, type of procedure, comorbidities, laboratory values, intraoperative factors, and SSI within 30 days of surgery, were determined using a logistic regression analysis. RESULTS Among 10,979 patients undergoing colorectal surgery (LAP 31.1%, open 68.9%), the SSI rate was 14.0% (9.5% LAP vs 16.1% open, p < 0.001). LAP patients were younger (p < 0.001), with lower American Society of Anesthesiologists (ASA) scores (p < 0.001) and comorbidities (p = 0.001) involving benign and inflammatory conditions rather than malignancy (p < 0.001), but operative time was greater (p = 0.001). On multivariate analysis age, ASA > or = 3, smoking, diabetes, operative time >180 minutes, appendicitis or diverticulitis, and regional enteritis diseases were found to be significantly associated with high SSI; the LAP approach was associated with a reduced SSI rate. CONCLUSIONS The LAP approach is independently associated with a reduced SSI when compared with open surgery and should, when feasible, be considered for colon and rectal conditions.
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Affiliation(s)
- Ravi P Kiran
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
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