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

Marcello Peter W. M.D.; Fleshman, James W. M.D.; Milsom, Jeffrey W. M.D.; Read, Thomas E. M.D.; Arnell, Tracey D. M.D.; Birnbaum, Elisa H. M.D.; Feingold, Daniel L. M.D.; Lee, Sang W. M.D.; Mutch, Matthew G. M.D.; Sonoda, Toyooki M.D.; Yan, Yan Ph.D.; Whelan, Richard L. M.D.
Diseases of the Colon & Rectum: June 2008
doi: 10.1007/s10350-008-9269-5
Original Contribution: PDF Only

Purpose: Purpose:This study was designed to compare short-term outcomes after hand-assisted laparoscopicvs.straight laparoscopic colorectal surgery.

Methods: 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: 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: 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.

Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.

Reprints are not available

Drs. Marcello, Read, and Mutch are consultants for Applied Medical and have received honoraria and potential stock options. Drs. Milsom and Whelan have received honoraria for speaking on behalf of Applied Medical. Applied Medical provided financial support to the institutions for the project.


© The ASCRS 2008