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

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Abstract

Purpose:

This study was designed to compare short-term outcomes after hand-assisted laparoscopicvs.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 ± 58vs. 208 ± 55;P= 0.021) and total colectomy groups (time to colectomy completion, 127 ± 31vs. 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 percentvs. 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.

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