Details

Autor(en) / Beteiligte

• Marcello, Peter W.
• Fleshman, James W.
• Milsom, Jeffrey W.
• Read, Thomas E.
• Arnell, Tracey D.
• Birnbaum, Elisa H.
• Feingold, Daniel L.
• Lee, Sang W.
• Mutch, Matthew G.
• Sonoda, Toyooki
• Yan, Yan
• Whelan, Richard L.

Titel

Hand-Assisted Laparoscopic vs. Laparoscopic Colorectal Surgery: A Multicenter, Prospective, Randomized Trial

Ist Teil von

• Diseases of the colon & rectum, 2008-06, Vol.51 (6), p.818-828

Ort / Verlag

New York: Springer-Verlag

Erscheinungsjahr

2008

Quelle

MEDLINE

Beschreibungen/Notizen

• Purpose This study was designed to compare short-term outcomes after hand-assisted laparoscopic vs. straight laparoscopic colorectal surgery. Methods Eleven surgeons at five centers participated in a prospective, randomized trial of patients undergoing elective laparoscopic sigmoid/left colectomy and total colectomy. The study was powered to detect a 30-minute reduction in operative time between hand-assisted laparoscopic and straight laparoscopic groups. Results There were 47 hand-assisted patients (33 sigmoid/left colectomy, 14 total colectomy) and 48 straight laparoscopic patients (33 sigmoid/left colectomy, 15 total colectomy). There were no differences in the patient age, sex, body mass index, previous surgery, diagnosis, and procedures performed between the hand-assisted and straight laparoscopic groups. Resident participation in the procedures was similar for all groups. The mean operative time (in minutes) was significantly less in the hand-assisted laparoscopic group for both the sigmoid colectomy (175 ± 58 vs . 208 ± 55; P  = 0.021) and total colectomy groups (time to colectomy completion, 127 ± 31 vs . 184 ± 72; P  = 0.015). There were no apparent differences in the time to return of bowel function, tolerance of diet, length of stay, postoperative pain scores, or narcotic usage between the hand-assisted laparoscopic and straight laparoscopic groups. There was one (2 percent) conversion in the hand-assisted laparoscopic group and six (12.5 percent) in the straight laparoscopic group ( P  = 0.11). Complications were similar in both groups (hand-assisted, 21 percent vs . straight laparoscopic, 19 percent; P  = 0.68). Conclusions In this prospective, randomized study, hand-assisted laparoscopic colorectal surgery resulted in significantly shorter operative times while maintaining similar clinical outcomes as straight laparoscopic techniques for patients undergoing left-sided colectomy and total abdominal colectomy.