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Zhang X, Wu Q, Gu C, Hu T, Bi L, Wang Z. Hand-assisted laparoscopic surgery versus conventional open surgery in intraoperative and postoperative outcomes for colorectal cancer: An updated systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7794. [PMID: 28816967 PMCID: PMC5571704 DOI: 10.1097/md.0000000000007794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM This meta-analysis aims to compare hand-assisted laparoscopic surgery (HALS) and conventional open surgery (OS) for colorectal cancer (CRC) in terms of intraoperative and postoperative outcomes, and to explore the safety, feasibility of HALS for CRC surgery. METHODS A systematic literature search with no limits was performed in PubMed, Embase, and Medline. The last search was performed on April 23, 2017. The outcomes of interests included intraoperative outcomes (operative time, blood loss, length of incision, transfusion, and lymph nodes harvested), postoperative outcomes (length of hospital stay, length of postoperative hospital stay, time to first flatus, time to first liquid diet, time to first soft diet, time to first bowel movement, postoperative complications, reoperation, ileus, anastomotic leakage, wound infection, urinary complication, pulmonary infection, and mortality). RESULTS Fifteen articles published between 2007 and 2017 with a total of 1962 patients with CRC were included in our meta-analysis. HALS was associated with longer operative time, less blood loss, smaller length of incision, shorter hospital days and postoperative hospital days, less time to first flatus, less wound infection, and less postoperative complications. There was no difference in blood transfusion, lymph node harvested, time to first liquid or soft diet, time to first bowel movement, reoperation, ileus, anastomotic leakage, pulmonary infection, urinary complications, or mortality. CONCLUSIONS Our meta-analysis suggests that HALS in CRC surgery improves cosmesis and results in better postoperative recovery outcomes by reducing postoperative complications and hospital days. Furthermore, a large randomized control study is warranted to compare the short-term and long-term outcomes of those 2 techniques for CRC treatment.
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Affiliation(s)
- Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Tao Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Liang Bi
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
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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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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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Hand-assisted Laparoscopic Colectomy for Colovesical Fistula Associated With Diverticular Disease. Surg Laparosc Endosc Percutan Tech 2014; 24:251-3. [DOI: 10.1097/sle.0b013e31828f6ce0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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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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Ozturk E, Kiran RP, Remzi F, Geisler D, Fazio V. Hand-assisted laparoscopic surgery may be a useful tool for surgeons early in the learning curve performing total abdominal colectomy. Colorectal Dis 2010; 12:199-205. [PMID: 19183331 DOI: 10.1111/j.1463-1318.2009.01777.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We evaluated outcomes after hand-assisted (HALC) and straight laparoscopic (LC) techniques for the initial laparoscopic total abdominal colectomy (TAC) procedures performed by surgeons starting their laparoscopic careers. METHOD The first eight HALC cases of two surgeons performing TAC by this technique (Group A) were compared with the first (Group B) and last eight (Group C) TAC cases of three surgeons performing LC. Groups A and B were compared with a matched group of open total colectomy cases (Group D) and to the eight cases performed by an experienced surgeon (Group E). Demographics, intra-operative and postoperative outcomes including operation time, morbidity, conversion and readmission rates and length of hospital stay (LOS) were compared using Wilcoxon or Chi-squared tests. RESULTS Demographics of the patients were similar. Groups A, B C and E had similar operating time (P = 0.10) which was significantly longer than Group D (P < 0.0001). Morbidity (P = 0.75) and readmission rates were similar (P = 0.89). Conversion rate was significantly higher for Group B (Group B: 41.7%vs Group A: 0%, P = 0.008), in the early period. LOS was comparable between minimally invasive groups but significantly shorter than open surgery group (P = 0.0005). For Groups A and C, operating time (P = 0.55), conversion rate (P = 0.11), morbidity (P = 0.83) and LOS (P = 0.12) were similar. CONCLUSIONS Hand-assisted laparoscopic colectomy may be associated with a significantly shorter learning curve for TAC as results are better than early LC and comparable with LC performed by experienced laparoscopic surgeons. It may be a better option for surgeons early in their laparoscopic career.
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Affiliation(s)
- E Ozturk
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio, USA
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Rink AD, John-Enzenauer K, Haaf F, Straub E, Nagelschmidt M, Vestweber KH. Laparoscopic-assisted or laparoscopic-facilitated sigmoidectomy for diverticular disease? A prospective randomized trial on postoperative pain and analgesic consumption. Dis Colon Rectum 2009; 52:1738-45. [PMID: 19966607 DOI: 10.1007/dcr.0b013e3181b552cf] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Laparoscopic-assisted sigmoidectomy is an attractive but sometimes challenging operative technique for the treatment of diverticulitis of the sigmoid colon. The aim of this study was to compare, with respect to early postoperative analgesic demand and postoperative pain, laparoscopic-assisted sigmoidectomy with a laparoscopic-facilitated technique. In the laparascopic-facilitated technique, the sigmoid colon is removed conventionally via a cosmetically inconspicuous incision after prior laparoscopic mobilization. PATIENTS AND METHODS Patients subjected to elective sigmoidectomy for diverticulitis were randomized to either laparoscopic-assisted or laparoscopic-facilitated sigmoidectomy. All patients had piritramide-based, patient-controlled analgesia. The cumulative postoperative consumption over 96 hours was defined as the primary end point. Postoperative pain, fatigue, pulmonary function, and resumption of bowel function were secondary endpoints. RESULTS : Forty-five patients were randomized according to the protocol to laparoscopic-assisted sigmoidectomy (n = 22) or laparoscopic-facilitated sigmoidectomy (n = 23). The analgesic consumption between the two groups was equivalent (61.3 (9-171) mg piritramide/96 hours vs. 64.3 (18-150) mg piritramide/96 hours; P = 0.827). Patients with laparoscopic-assisted sigmoidectomy had lower pain levels on Day one and Day two. Cumulative pain levels over 96 hours and over the whole 7-day observation period, however, were not significantly different, although postoperative fatigue and pulmonary function were significantly different. Duration of surgery was slightly shorter for laparoscopic-assisted sigmoidectomy (127 (47-200) vs. 135 (60-239) minutes; P = 0.28), but recovery of bowel activity was faster after laparoscopic-facilitated surgery. There was no significant difference in morbidity. CONCLUSION Overall, the postoperative outcome was roughly equivalent after both techniques of laparoscopic sigmoidectomy. Therefore, laparoscopic-facilitated sigmoidectomy could be considered as an alternative to laparoscopic-assisted sigmoidectomy in technically difficult cases of diverticulitis subjected to laparoscopic surgery.
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Affiliation(s)
- Andreas D Rink
- Leverkusen General Hospital, Department of General Surgery, Leverkusen, Germany.
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Ozturk E, Kiran RP, Geisler DP, Hull TL, Vogel JD. Hand-assisted laparoscopic colectomy: benefits of laparoscopic colectomy at no extra cost. J Am Coll Surg 2009; 209:242-7. [PMID: 19632601 DOI: 10.1016/j.jamcollsurg.2009.03.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 03/10/2009] [Accepted: 03/11/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Comparison studies of hand-assisted and laparoscopic-assisted colectomy have indicated that short-term outcomes are similar. Although a few of these studies have compared costs, none has reported on the costs of hand-assisted colectomy performed in the US. Our aim was to determine the short-term outcomes and direct costs associated with hand-assisted and laparoscopic-assisted colectomy performed in the US. STUDY DESIGN One hundred hand-assisted laparoscopic colectomies were matched to 100 laparoscopic-assisted colectomies performed concurrently. Matching criteria were age (+/- 10 years), gender, diagnosis, American Society of Anesthesiologists score, earlier abdominal operation, colectomy type, and conversion. Operative time, morbidity, length of stay, reoperation, and readmission were assessed. Direct costs for the operating room, nursing care, intensive care, anesthesia, laboratory, pharmacy, radiology, emergency services and consultations, and professional and ancillary services related to the initial hospitalization and readmissions were compared. RESULTS From June 2005 to August 2008, 176 hand-assisted and 845 laparoscopic-assisted segmental and total colectomies were performed. Of 100 matched hand-assisted and laparoscopic-assisted patients, there were no differences in body mass index (29 and 28, respectively), operating time (168 and 163 minutes, respectively), length of stay (4 days), readmission (6% and 11%, respectively), or reoperation rates (5% and 9%, respectively). Overall morbidity was 16% and 32% for hand-assisted and laparoscopic-assisted colectomy, respectively (p = 0.009). Major morbidity, including abscess, hemorrhage, and anastomotic leak, were similar. Operating room costs were increased for hand-assisted colectomy (3,476 versus 3,167 US dollars); total costs were similar (8,521 versus 8,373 US dollars). CONCLUSIONS Short-term outcomes and total costs of hand-assisted and laparoscopic-assisted colectomy are similar.
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Affiliation(s)
- Ersin Ozturk
- Department of Colorectal Surgery, The Cleveland Clinic, Cleveland, OH 44195, USA
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