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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: 0.3] [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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Greemland I, Raveh G, Gavrielli S, Sadot E, Kashtan H, Wasserberg N. High Rates of Incisional Hernia After Laparoscopic Right Colectomy With Midline Extraction Site. Surg Laparosc Endosc Percutan Tech 2021; 31:722-728. [PMID: 34320593 DOI: 10.1097/sle.0000000000000977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic surgery aims at reducing wound complications and improving cosmetics, among other advantages. High rates of postoperative ventral hernia (POVH) are observed after laparoscopic-assisted colectomies. MATERIALS AND METHODS In a 2011 to 2016 retrospective study of all patients at Rabin Medical Center, we examined POVH prevalence after right hemicolectomy for neoplasia and correlation to specimen extraction site. We also compared laparoscopic-assisted colectomy to hand-assisted laparoscopic colectomy. Included were patients who had postoperative abdominal computed tomography or magnetic resonance imaging scan as part of their routine oncological follow-up to 6 months postsurgery. Patients were excluded for conversion to laparotomy, and prior abdominal surgeries after right colectomy and before follow-up computed tomography/magnetic resonance imaging scan. Demographic and surgical data were collected from patient electronic records, and scans reviewed for POVH by a designated radiologist. RESULTS Of 370 patients, 138 (mean age 70.09 y, 58 males) were included: 54 (39.1%) were diagnosed with POVH, 42/72 (58.3%) at midline extraction site, and 12/66 (18.8%) at off-midline extraction sites (P<0.0001). Surgical site infections and patients positive for tumor metastasis were associated with higher POVH rates. Most (74%) POVHs were identified within 18 months postsurgery (P<0.0001). Body mass index, age, sex, diabetes mellitus, smoking, tumor size, lymph nodes positive for metastasis, and hand-assisted laparoscopic colectomy were not associated with POVH prevalence. CONCLUSION High rates of radiologically diagnosed POVH were found after laparoscopic-assisted colectomy, with association to midline extraction site, surgical site infections, and positive tumor distant metastasis.
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Affiliation(s)
- Itzhak Greemland
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Raveh
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Gavrielli
- Department of Imaging, Rabin Medical Center, Beilinson Hospital, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Sadot
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Wasserberg
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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"Peek port": avoiding conversion during laparoscopic colectomy-an update. Surg Endosc 2019; 34:3944-3948. [PMID: 31586252 DOI: 10.1007/s00464-019-07165-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the efficacy of a method to avoid conversion to laparotomy in patients considered for laparoscopic colectomy. Patients considered being at high risk for conversion to formal laparotomy were initially approached via a small midline incision ("peek port") with the laparoscopic equipment readily available but unopened. If intraperitoneal conditions were favorable, the procedure was performed using hand-assisted laparoscopy (HALS); if intraperitoneal conditions were unfavorable, the incision was extended to a formal laparotomy. METHODS Data from 664 patients from a single surgeon brought to the operating room with the intention of proceeding with laparoscopic colectomy (either via straight laparoscopy or HALS) were retrieved from a prospective database. Comparison of conversion rates between groups was performed using χ2 analysis. RESULTS The study population consisted of 361 men and 303 women with a mean age of 61 years. Inflammatory conditions accounted for 40% of the diagnoses and enteric fistulas were present in 12%. Of the 79 patients who underwent initial "peek port" exploration, 38 (48%) underwent immediate extension to formal laparotomy, whereas 41 (52%) underwent HALS colectomy, with one subsequent conversion from HALS to formal laparotomy. Of the 585 patients initially approached laparoscopically, 14 (2%) required conversion to laparotomy. Of the 626 patients from both groups who underwent laparoscopy, the overall conversion to laparotomy rate was 15/626 (2%). DISCUSSION The "peek port" approach to the patients with a potentially hostile abdomen allows for prompt assessment of intraperitoneal conditions and is associated with an overall low rate of conversion from laparoscopy to laparotomy during colectomy. This technique may reduce expense and morbidity for patients who ultimately require laparotomy, while allowing some patients with complex disease to be managed laparoscopically who would not normally be considered for a minimally invasive procedure.
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Song XJ, Liu ZL, Zeng R, Ye W, Liu CW. A meta-analysis of laparoscopic surgery versus conventional open surgery in the treatment of colorectal cancer. Medicine (Baltimore) 2019; 98:e15347. [PMID: 31027112 PMCID: PMC6831213 DOI: 10.1097/md.0000000000015347] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This meta-analysis aimed to explore the overall effect and safety of anterior laparoscopic surgery versus conventional open surgery for patients with colorectal cancer based on eligible randomized controlled trials (RCTs), especially the difference in the postoperative incidence of deep venous thrombosis (DVT). METHODS PubMed, Cochrane, and Embase were searched based on keywords to identify eligible studies before February 2018. Only RCTs were eligible. We analyzed the main outcomes using the relative risk (RR) or mean difference (MD) along with 95% confidence interval (95% CI). RESULTS In this meta-analysis, we analyzed a total of 24 studies with 4592 patients in the laparoscopic surgery group and 3865 patients in the open surgery group. The results indicated that compared with the open surgery, laparoscopic surgery significantly decreased estimated blood loss (SMD: -1.14, 95%CI: -1.70 to -0.57), hospital stay (SMD: -1.12, 95%CI: -1.76 to -0.47), postoperative mortality (RR: 0.60, 95%CI: 0.41-0.86) and postoperative complication (RR: 0.83, 95%CI: 0.72-0.95). However, the operative time (WMD: 40.46, 95%CI: 35.94-44.9) was statistically higher in the laparoscopic surgery group than the open surgery group, and there was no significant difference in the incidence of DVT between the 2 groups (RR: 0.96, 95%CI: 0.46-2.02). CONCLUSION Laparoscopic surgery is superior to open surgery for patients with colorectal cancer. But the 2 surgeries showed no significant difference in the incidence of DVT.
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Zhang X, Wu Q, Hu T, Gu C, Bi L, Wang Z. Laparoscopic versus conventional open surgery in T4 rectal cancer: A case-control study. J Minim Access Surg 2019; 15:37-41. [PMID: 30416145 PMCID: PMC6293675 DOI: 10.4103/jmas.jmas_67_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Laparoscopic surgery (LAS) for T4 rectal cancer (RC) is still controversial. This study aims to compare LAS with conventional open surgery in patients with T4 RC. Patients and Methods: Patients undergoing laparoscopic or open curative resection for T4 RC from January 2010 to September 2014 in our hospital were enrolled. Patients’ clinicopathological characteristics and survival outcomes were collected and compared. All statistical analysis was performed using SPSS 22.0. Results: A total of 125 patients (39 open, 86 LAS) were included in this study finally. The baseline information between the two groups were comparable except that LAS group had a more anterior resection (P = 0.012) and less combined resection (P = 0.003). The results demonstrated that patients in LAS group had less blood loss (P < 0.001), smaller incision length (P < 0.001), faster time to first soft diet (P = 0.010) and less incidence of post-operative complications, although it was not significantly different (P = 0.063). In addition, the operative time was also comparable (P = 0.140) and the conversion rate was low (2/86). The 3-year overall survival (OS) was 71.8%, 79.1% in open, LAS group respectively and the 3-year disease-free survival (DFS) was 66.7%, 68.6% in open, laparoscopic group, respectively. The Kaplan curves demonstrated that there was no significant difference between the two groups in OS (P = 0.981) or DFS (P = 0.900). Conclusions: LAS is safe and feasible in selected patients with T4 RC. It can achieve a better perioperative outcomes, and the long-time survival is not inferior to open surgery. Prospective studies should be conducted in the future to reduce the selection bias.
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Affiliation(s)
- Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital; West China School of Medicine, Sichuan University, Chengdu, China
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital; West China School of Medicine, Sichuan University, Chengdu, China
| | - Tao Hu
- Department of Gastrointestinal Surgery, West China Hospital; West China School of Medicine, Sichuan University, Chengdu, China
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Bi
- Department of Gastrointestinal Surgery, West China Hospital; West China School of Medicine, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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Tan ECH, Yang MC, Chen CC. Effects of laparoscopic surgery on survival, quality of care and utilization in patients with colon cancer: a population-based study. Curr Med Res Opin 2018; 34:1663-1671. [PMID: 29863425 DOI: 10.1080/03007995.2018.1484713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Laparoscopy is a safe and effective treatment for colon cancer. However, its effects on short- and long-term health outcomes and medical utilization are not fully elucidated. This study aimed to compare short- and long-term utilization and health outcomes of colon cancer patients who underwent either laparoscopic or open surgery in a population-based cohort. METHODS This study was conducted by linking data from Taiwan Cancer Registry, National Health Insurance claims and Death Registry. Patients aged 18 and older with colon cancer between 2009 and 2012 were included in the study. Propensity score matching was used to minimize selection bias between laparoscopic and open surgery groups. Cox proportional hazard regression and generalized linear mixed logistic regression were used to test hypotheses. RESULTS Among the 11,269 colon cancer patients who underwent colectomy, 3236 (28.72%) received laparoscopy and 8033 (71.28%) underwent open surgery. Patients who received laparoscopic surgery had better overall survival (HR = 0.82; 95% CI: 0.70-0.97). These patients also had lower 30 day mortality (0.44% vs. 0.91%), lower 1 year mortality (2.83% vs. 4.68%), lower overall occurrence of complications (6.16% vs. 8.77%), shorter mean length of stay (12.53 vs. 14.93 days) and lower cost for index hospitalization (US$4325.34 vs. US$4453.90). No significant differences were observed in medical utilization over a period of 365 days after the surgery. CONCLUSIONS Our results demonstrate that, in both the short- and long-term post-operation periods, laparoscopic surgery reduced the likelihood of postoperative complications, 30 day, and 1 year mortality while being no more expensive than open surgery for colon cancer.
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Affiliation(s)
- Elise Chia-Hui Tan
- a Division of Clinical Chinese Medicine , National Research Institute of Chinese Medicine , Ministry of Health and Welfare , Taipei , Taiwan
- b Institute of Health Policy and Management , College of Public Health , National Taiwan University , Taipei , Taiwan
| | - Ming-Chin Yang
- b Institute of Health Policy and Management , College of Public Health , National Taiwan University , Taipei , Taiwan
| | - Chien-Chih Chen
- c Department of Surgery , Koo Foundation, Sun Yat-Sen Cancer Center , Taipei , Taiwan
- d College of Medicine , National Yang-Ming University , Taipei , Taiwan
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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: 0.1] [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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Negoi I, Hostiuc S, Negoi RI, Beuran M. Laparoscopic vs open complete mesocolic excision with central vascular ligation for colon cancer: A systematic review and meta-analysis. World J Gastrointest Oncol 2017; 9:475-491. [PMID: 29290918 PMCID: PMC5740088 DOI: 10.4251/wjgo.v9.i12.475] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/08/2017] [Accepted: 09/07/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To compare the effectiveness of laparoscopic complete mesocolic excision (CME) with central vascular ligation (L-CME) with its open (O-CME) counterpart.
METHODS We conducted an electronic search of the PubMed/MEDLINE, Excerpta Medica Database, Web of Science Core Collection, Cochrane Center Register of Controlled Trails, Cochrane Database of Systematic Reviews, SciELO, and Korean Journal databases from their inception until May 2017. We considered randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that included patients with colonic cancer comparing L-CME and O-CME. Primary outcomes included the quality of the resected specimen (lymph nodes retrieved, complete mesocolic plane excision, tumor to arterial high tie, resected mesocolon surface). Secondary outcomes included the three-year and five-year overall and disease-free survival rates, recurrence of the disease, surgical data, and postoperative morbidity and mortality. Two authors of the review screened the methodological quality of the eligible trials and independently extracted data from individual studies.
RESULTS A total of one RCT and eleven CCTs (four from Europe and seven from Asia) met the inclusion criteria for the current meta-analysis. These studies involved 1619 patients in L-CME and 1477 patients in O-CME. The L-CME was associated with the same quality of the resected specimen, with no differences regarding the retrieved lymphnodes (MD = -1.06, 95%CI: -3.65 to 1.53, P = 0.42), and tumor to high tie distance (MD = 14.26 cm, 95%CI: -4.30 to 32.82, P = 0.13); the surface of the resected mesocolon was higher in the L-CME group (MD = 11.75 cm2, 95%CI: 9.50 to 13.99, P < 0.001). The L-CME was associated with a lower rate of blood transfusions (OR = 0.45, 95%CI: 0.27 to 0.75, P = 0.002), faster recovery of gastrointestinal function, and less postoperative overall complication rate. The L-CME approach was associated with a statistical significant better three-year overall (OR = 2.02, 95%CI: 1.31 to 3.12, P = 0.001, I2 = 28%) and disease-free (OR = 1.45, 95% CI: 1.00 to 2.10, P = 0.05, I2 = 0%) survival.
CONCLUSION The laparoscopic approach offers the same quality of the resected specimen as the open approach in complete mesocolic excision with central vascular ligation for colon cancer. The laparoscopic complete mesocolic excision with central vascular ligation is superior in all perioperative results and at least non-inferior in long-term oncological outcomes.
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Affiliation(s)
- Ionut Negoi
- Department of General Surgery, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
| | - Sorin Hostiuc
- National Institute of Legal Medicine Mina Minovici, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
| | - Ruxandra Irina Negoi
- Department of Anatomy, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
| | - Mircea Beuran
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
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Zhang X, Wu Q, Hu T, Gu C, Bi L, Wang Z. Hand-Assisted Laparoscopic Surgery Versus Conventional Laparoscopic Surgery for Colorectal Cancer: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2017; 27:1251-1262. [PMID: 28813634 DOI: 10.1089/lap.2017.0210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM This meta-analysis aims to compare hand-assisted laparoscopic surgery (HALS) with conventional laparoscopic surgery (LAS) for colorectal cancer (CRC) in terms of intraoperative, postoperative, and survival outcomes. MATERIALS AND METHODS A systematic literature search with no limits was performed in PubMed, Embase, and Medline. The last search was performed on March 31, 2017. The outcomes of interests included intraoperative outcomes (operative time, blood loss, length of incision, transfusion, conversion, and lymph nodes harvested), postoperative outcomes (length of hospital stay, time to first flatus, time to first bowel movement, postoperative complications, mortality, reoperation, ileus, anastomotic leakage, postoperative bleeding, wound infection, intra-abdominal abscess, urinary complication, cardiopulmonary complication, and readmission), and 5-year survival outcomes. RESULTS Nine articles published between 2007 and 2016 with a total of 1307 patients were enrolled in this meta-analysis. HALS was associated with longer length of incision. No differences were found for operative time, blood loss, transfusion, conversion, lymph nodes harvested, length of hospital stay, time to first flatus, time to first bowel movement, postoperative complications, mortality, reoperation, ileus, anastomotic leakage, postoperative bleeding, wound infection, intra-abdominal abscess, urinary complication, cardiopulmonary complication, readmission, or 5-year survival outcomes. CONCLUSION Our meta-analysis demonstrated that HALS is similar to LAS for CRC surgery in terms of intraoperative, postoperative, and survival outcomes except for the longer length of incision.
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Affiliation(s)
- Xubing Zhang
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .,2 West China School of Medicine, Sichuan University , Chengdu, China
| | - Qingbin Wu
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .,2 West China School of Medicine, Sichuan University , Chengdu, China
| | - Tao Hu
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .,2 West China School of Medicine, Sichuan University , Chengdu, China
| | - Chaoyang Gu
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China
| | - Liang Bi
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .,2 West China School of Medicine, Sichuan University , Chengdu, China
| | - Ziqiang Wang
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China
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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: 0.8] [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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Weissler JM, Lanni MA, Hsu JY, Tecce MG, Carney MJ, Kelz RR, Fox JP, Fischer JP. Development of a Clinically Actionable Incisional Hernia Risk Model after Colectomy Using the Healthcare Cost and Utilization Project. J Am Coll Surg 2017; 225:274-284.e1. [PMID: 28445797 DOI: 10.1016/j.jamcollsurg.2017.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/10/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Incisional hernia remains a persistent and burdensome complication after colectomy. Through individualized risk-assessment and prediction models, we aimed to improve preoperative risk counseling for patients undergoing colectomy; identify modifiable preoperative risk factors; and encourage the use of evidence-based risk-prediction instruments in the clinical setting. STUDY DESIGN A retrospective review of the Healthcare Cost and Utilization Project data was conducted for all patients undergoing either open or laparoscopic colectomy as identified through the state inpatient databases of California, Florida, and New York in 2009. Incidence of incisional hernia repair was collected from both the state inpatient databases and the state ambulatory surgery and services databases in the 3 states between index surgery and 2011. Hernia risk was calculated with multivariable hierarchical logistic regression modeling and validated using bootstrapping techniques. Exclusion criteria included concurrent hernia, metastasis, mortality, and age younger than 18 years. Inflation-adjusted expenditure estimates were calculated. RESULTS Overall, 30,741 patients underwent colectomy, one-third of these procedures performed laparoscopically. Incisional hernia repair was performed in 2,563 patients (8.3%) (27-month follow-up). Fourteen significant risk factors were identified, including open surgery (odds ratio = 1.49; p < 0.0001), obesity (odds ratio = 1.49; p < 0.0001), and alcohol abuse (odds ratio = 1.39; p = 0.010). Extreme-risk patients experienced the highest incidence of incisional hernia (19.8%) vs low-risk patients (3.9%) (C-statistic = 0.67). CONCLUSIONS We present a clinically actionable model of incisional hernia using all-payer claims after colectomy. The data presented can structure preoperative risk counseling, identify modifiable patient-specific risk factors, and advance the field of risk prediction using claims data.
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Affiliation(s)
- Jason M Weissler
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Michael A Lanni
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jesse Y Hsu
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Michael G Tecce
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Martin J Carney
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Rachel R Kelz
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Justin P Fox
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - John P Fischer
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
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Tajima T, Mukai M, Yokoyama D, Higami S, Uda S, Hasegawa S, Nomura E, Sadahiro S, Yasuda S, Makuuchi H. Comparison of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy in patients with colorectal cancer: Final results from a single center. Oncol Lett 2017; 13:4953-4958. [PMID: 28588735 DOI: 10.3892/ol.2017.6035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/31/2017] [Indexed: 01/31/2023] Open
Abstract
In recent years, the use of laparoscopic surgery has been expanded to include radical curative resection. In a previous study, 212 patients with primary colorectal cancer (stages I-III) underwent radical curative resection by hand-assisted laparoscopic surgery (HALS) (n=98) or conventional laparotomy (CL) (n=114) and were compared with respect to 3-year relapse-free survival (3Y-RFS) and 3-year overall survival (3Y-OS). The study included 210/212 patients who were followed up to 5 years, including 96 patients who underwent HALS and 114 treated with CL. The two groups were matched for stage, clinical background, and postoperative management. Patient characteristics were compared and the 5Y-RFS and 5Y-OS were determined. The 5-year follow-up rate was 97.6%. In stage I-III patients, 5Y-RFS and 5Y-OS showed no significant differences between HALS and CL. The patients with stage I disease accounted for 41.7% (40/96) of the patients undergoing HALS, while stage I patients only accounted for 23.7% (27/114) of the patients undergoing CL, and the difference was significant (P=0.005). Stage II patients undergoing CL were older than those treated with HALS (P=0.017). However, there were no differences in the characteristics of stage III patients undergoing HALS or CL. In conclusion, HALS achieved a similar survival to CL in patients with stage I to III colorectal cancer. Compared with CL, HALS was performed more safely and achieved superior cosmetic results.
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Affiliation(s)
- Takayuki Tajima
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Masaya Mukai
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Daiki Yokoyama
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Shigeo Higami
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Shuji Uda
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Sayuri Hasegawa
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Eiji Nomura
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Sotaro Sadahiro
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Seiei Yasuda
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Hiroyasu Makuuchi
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan.,Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
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Leraas HJ, Ong CT, Sun Z, Adam MA, Kim J, Gilmore BF, Ezekian B, Nag US, Mantyh CR, Migaly J. Hand-Assisted Laparoscopic Colectomy Improves Perioperative Outcomes Without Increasing Operative Time Compared to the Open Approach: a National Analysis of 8791 Patients. J Gastrointest Surg 2017; 21:684-691. [PMID: 28083836 DOI: 10.1007/s11605-016-3350-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/30/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Hand-assisted laparoscopic surgery (HALS) is often used in procedures too complex for completely minimally invasive approaches. However, there are concerns for whether this hybrid approach abrogates perioperative benefits of the completely minimally invasive technique. METHODS We queried the 2012-2013 National Surgery Quality Improvement Program for adults undergoing elective HALS or open colectomy (OC). After propensity matching, short-term outcomes were compared. Subset analysis was performed for segmental resections. Multivariate analysis was used to determine predictors of utilizing either approach. RESULTS This query included 8791 patients (OC 2707, HALS 6084). Predictors of HALS included male sex (OR 1.17, p = 0.006), increasing BMI (OR 1.01, p = 0.02), benign indication (OR 1.48, p < 0.001), and total abdominal colectomy (OR 10.39, p < 0.001). Younger age, black race, ASA class ≥3, inflammatory bowel disease, and low pelvic anastomosis were predictive of OC (all p < 0.05). HALS demonstrated reduced overall complications (p < 0.001), wound complications (p < 0.001), anastomotic leak (p = 0.014), transfusion (p < 0.001), postoperative ileus (p < 0.001), length of stay (p < 0.001), and readmission (p < 0.001) without increased operative time. For segmental resection, HALS demonstrated reduced overall complications, wound complications, respiratory complications, postoperative ileus, anastomotic leak, transfusion, length of stay, and readmissions (all p < 0.05). CONCLUSIONS Compared to OC, HALS demonstrates improved perioperative outcomes without increased operative time.
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Affiliation(s)
- Harold J Leraas
- Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
| | - Cecilia T Ong
- 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 A 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 F Gilmore
- 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
| | - Uttara S Nag
- 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
| | - John Migaly
- Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA
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Wu QB, Deng XB, Yang XY, Chen BC, He WB, Hu T, Wei MT, Wang ZQ. Hand-assisted laparoscopic right hemicolectomy with complete mesocolic excision and central vascular ligation: a novel technique for right colon cancer. Surg Endosc 2016; 31:3383-3390. [DOI: 10.1007/s00464-016-5354-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 11/09/2016] [Indexed: 02/06/2023]
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Julien M, Dove J, Quindlen K, Halm K, Shabahang M, Wild J, Blansfield J. Evolution of Laparoscopic Surgery for Colorectal Cancer: The Impact of the Clinical Outcomes of Surgical Therapy Group Trial. Am Surg 2016. [DOI: 10.1177/000313481608200825] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The Clinical Outcomes of Surgical Therapy Group (COST) Trial established laparoscopic procedures offer short-term benefits while preserving the same oncologic outcomes in colorectal cancer (CRC) patients compared with open procedures. The aim of this study was to evaluate the trend of laparoscopic resection for CRC before and after the publication of the COST Trial. Retrospective study of surgically treated CRC patients was conducted from January 2000 to December 2009. Surveillance, Epidemiology, and End Results Program and Medicare. Between 2000 and 2009, 147,388 patients underwent resection for CRC, 9,901 resections were performed laparoscopically. In 2000, 1.0 per cent of colorectal resections were performed laparoscopically. There was a dramatic increase in laparoscopic resections in 2009 to 30.4 per cent. During this time period, rates of laparoscopic resections increased for all tumor stages. Right colectomies and early stage tumors had the most significant rise from 3.1 per cent (2004) to 38.7 per cent (2009) and 4.41 per cent (2004) to 39.17 per cent (2009), respectively; whereas, rectal and later stage tumors resection rates were more modest from 2.1 per cent (2004) to 13.2 per cent (2009) and 1.41 per cent (2004) to 17.10 per cent (2009), respectively. This study demonstrates the COST Trial had a significant impact on utilization of laparoscopic colorectal resection for CRC. Although laparoscopic colorectal resections have been accepted for all types of CRCs, more difficult procedures are being adopted at slower rates.
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Affiliation(s)
| | - James Dove
- Geisinger Medical Center, Danville, Pennsylvania
| | | | - Kristen Halm
- Geisinger Medical Center, Danville, Pennsylvania
| | | | - Jeffrey Wild
- Geisinger Medical Center, Danville, Pennsylvania
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Benlice C, Costedio M, Stocchi L, Abbas MA, Gorgun E. Hand-assisted laparoscopic vs open colectomy: an assessment from the American College of Surgeons National Surgical Quality Improvement Program procedure-targeted cohort. Am J Surg 2016; 212:808-813. [PMID: 27324382 DOI: 10.1016/j.amjsurg.2016.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 02/01/2016] [Accepted: 02/09/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Perioperative outcomes of patients who underwent hand-assisted colorectal laparoscopic (HALS) vs open colectomy were compared using recently released procedure-targeted database. METHODS Review was conducted using the 2012 colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database. Patients were classified into 2 groups according to final surgical approach: HALS vs open (planned). Groups were matched (1:1) based on age, gender, body mass index, surgical procedure, diagnosis, American Society of Anesthesiologists score, and wound classification. Multivariate logistic regression analysis was conducted for group comparison. RESULTS Of 7,303 patients, 1,740 patients were matched in each group. Open group had higher proportion of patients with preoperative dyspnea (P = .01), ascites (P = .01), weight loss (P < .001), smoking history (P = .04), and increased work relative value units (P < .001). After adjusting for difference in baseline comorbidities, overall morbidity, superficial, deep, and organ-space surgical site infection, urinary tract infection, ileus, reoperation, readmission, and hospital stay were significantly higher in open group (P < .05). CONCLUSIONS National Surgical Quality Improvement Program targeted-data demonstrated several advantages of HALS compared with open colonic resection including shorter hospital stay and lower complication rate. Further adoption of HALS technique as a bridge to straight laparoscopy or tool in difficult cases can positively impact the short-term outcomes after colectomy when compared with open technique.
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Affiliation(s)
- Cigdem Benlice
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-30, Cleveland, OH 44195, USA
| | - Meagan Costedio
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-30, Cleveland, OH 44195, USA
| | - Luca Stocchi
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-30, Cleveland, OH 44195, USA
| | - Maher A Abbas
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-30, Cleveland, OH 44195, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-30, Cleveland, OH 44195, USA.
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Yamada T, Okabayashi K, Hasegawa H, Tsuruta M, Yoo JH, Seishima R, Kitagawa Y. Meta-analysis of the risk of small bowel obstruction following open or laparoscopic colorectal surgery. Br J Surg 2016; 103:493-503. [DOI: 10.1002/bjs.10105] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 12/13/2015] [Accepted: 12/14/2015] [Indexed: 12/17/2022]
Abstract
Abstract
Background
One of the potential advantages of laparoscopic compared with open colorectal surgery is a reduction in postoperative bowel obstruction events. Early reports support this proposal, but accumulated evidence is lacking.
Methods
A systematic review and meta-analysis was performed of randomized clinical trials and observational studies by searching the PubMed and Cochrane Library databases from 1990 to August 2015. The primary outcomes were early and late postoperative bowel obstruction following laparoscopic and open colorectal surgery. Both ileus and bowel obstruction were defined as a postoperative bowel obstruction. Subgroup and sensitivity analyses were performed, and a random-effects model was used to account for the heterogeneity among the studies.
Results
Twenty-four randomized clinical trials and 88 observational studies were included in the meta-analysis; 106 studies reported early outcome and 12 late outcome. Collectively, these studies reported on the outcomes of 148 392 patients, of whom 58 133 had laparoscopic surgery and 90 259 open surgery. Compared with open surgery, laparoscopic surgery was associated with reduced rates of early (odds ratio 0·62, 95 per cent c.i. 0·54 to 0·72; P < 0·001) and late (odds ratio 0·61, 0·41 to 0·92; P = 0·019) postoperative bowel obstruction. Weighted mean values for early postoperative bowel obstruction were 8 (95 per cent c.i. 6 to 10) and 5 (3 to 7) per cent for open and laparoscopic surgery respectively, and for late bowel obstruction were 4 (2 to 6) and 3 (1 to 5) per cent respectively.
Conclusion
The reduction in postoperative bowel obstruction demonstrates an advantage of laparoscopic surgery in patients with colorectal disease.
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Affiliation(s)
- T Yamada
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - K Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - H Hasegawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - M Tsuruta
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - J-H Yoo
- Department of Surgery, National Hospital Organization Saitama National Hospital, 2–1 Suwa Wako, Saitama, Japan
| | - R Seishima
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Y Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Pascual M, Salvans S, Pera M. Laparoscopic colorectal surgery: Current status and implementation of the latest technological innovations. World J Gastroenterol 2016; 22:704-717. [PMID: 26811618 PMCID: PMC4716070 DOI: 10.3748/wjg.v22.i2.704] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studies and meta-analyses have shown that laparoscopic colorectal surgery is associated with the same benefits than other minimally invasive procedures, including lesser pain, earlier recovery of bowel transit and shorter hospital stay. On the other hand, despite initial concerns about oncological safety, well-designed prospective randomized multicentre trials have demonstrated that oncological outcomes of laparoscopy and open surgery are similar. Although the use of laparoscopy in colorectal surgery has increased in recent years, the percentages of patients treated with surgery using minimally invasive techniques are still reduced and there are also substantial differences among centres. It has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic colectomy rather than the tumour of patients’ characteristics. In this regard, future efforts to increase the use of laparoscopic techniques in colorectal surgery will necessarily require more efforts in teaching surgeons. We here present a review of recent controversies of the use of laparoscopy in colorectal surgery, such as in rectal cancer operations, the possibility of reproducing complete mesocolon excision, and the benefits of intra-corporeal anastomosis after right hemicolectomy. We also describe the results of latest innovations such as single incision laparoscopic surgery, robotic surgery and natural orifice transluminal endoscopic surgery for colon and rectal diseases.
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Miyagaki H, Rhee R, Shantha Kumara HMC, Yan X, Njoh L, Cekic V, Whelan RL. Surgical Treatment of Diverticulitis: Hand-Assisted Laparoscopic Resection Is Predominantly Used for Complex Cases and Is Associated With Increased Postoperative Complications and Prolonged Hospitalization. Surg Innov 2015; 23:277-83. [PMID: 26611789 DOI: 10.1177/1553350615618285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction Laparoscopic (LAP) colectomy is now the "gold" standard for diverticulitis; the role of hand-assisted LAP (HAL) and Open methods today is unclear. This study assessed the elective use of these methods for diverticulitis. Methods A retrospective review of demographic, comorbidity (Carlson Comorbidity Index [CCI]), resection type, and short-term outcomes was carried out. Results There were 125 (44.5%) LAP, 125 (44.5%) HAL, and 31 (11%) Open cases (overall N = 281). The mean age, body mass index, and percentage of high-risk patients (CCI score >2) of the HAL group were greater (P < .05) than the LAP group (vs Open, P = ns). The Open group's mean age and percent with CCI >2 was greater when compared with the LAP group (P < .05). More Open (P < .05) and HAL patients had complex disease (Open, 63%; HAL, 40%, LAP, 22%) and were diverted (Open, 35%; HAL, 10%; LAP, 3%). Time to bowel movement was not different; however, there was a stepwise increase in median length of stay (LOS; days) from the LAP (5 days) to HAL (6 days) to Open group (7 days) (P < .05 for all). The LAP complication rate (22.4%) was lower (P < .05) than the HAL (42.4%) or Open groups' (45.2%) rates. The LAP surgical site infection rate (5.6%) was lower (P < .05) than the HAL (12.8%) or Open groups (19.6%). Conclusion The HAL and Open groups had more high risk, complex disease, diverted, and older patients than the LAP group; likewise, the overall complication rate and LOS was higher in the HAL and Open groups. Use of HAL methods likely contributed to the high minimally invasive surgery utilization rate (89%).
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Affiliation(s)
- Hiromichi Miyagaki
- Mount Sinai Roosevelt Hospital Center, New York, NY, USA Saiseikai Senri Hospital, Suita, Osaka, Japan
| | - Rebecca Rhee
- Mount Sinai Roosevelt Hospital Center, New York, NY, USA
| | | | - Xiaohong Yan
- Mount Sinai Roosevelt Hospital Center, New York, NY, USA
| | - Linda Njoh
- Mount Sinai Roosevelt Hospital Center, New York, NY, USA
| | - Vesna Cekic
- Mount Sinai Roosevelt Hospital Center, New York, NY, USA
| | - Richard L Whelan
- Mount Sinai Roosevelt Hospital Center, New York, NY, USA Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Tajima T, Mukai M, Noguchi W, Higami S, Uda S, Yamamoto S, Hasegawa S, Nomura E, Sadahiro S, Yasuda S, Makuuchi H. Comparison of hand-assisted laparoscopic surgery and conventional laparotomy for rectal cancer: Interim results from a single center. Mol Clin Oncol 2015; 3:533-538. [PMID: 26137262 DOI: 10.3892/mco.2015.508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/27/2015] [Indexed: 12/24/2022] Open
Abstract
Minimally invasive laparoscopic surgery has become widespread and the indications for such surgery have recently been extended to various conditions, including rectal cancer. The objective of this study was to compare the clinical outcome of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy (CL) in patients with rectal cancer. Patients who underwent radical resection of stage I-III primary rectal cancer (n=111) were classified into those receiving HALS (n=57) and those receiving CL (n=54); the two groups were matched for stage and postoperative treatment. The 3-year relapse-free survival (3Y-RFS) and 3-year overall survival (3Y-OS) were calculated and compared between the two groups. Intraoperative blood loss, operating time, postoperative hospital stay and complications were also compared between the two groups. There were no significant differenceS in 3Y-RFS or 3Y-OS between the HALS and CL groups for patients with all-stage (I, II and III) rectal cancer. The mean (median) intraoperative blood loss was 344.0 (247.0) ML in the HALS group vs. 807.5 (555.5) ML in the CL group (P<0.001). The mean (median) postoperative hospital stay was 19.8 (17) and 25.5 (18.3) days, respectively (P=0.039). There were no significant differences in the operating time or the incidence of complications between the two groups. Based on these results, HALS was found to be comparable to CL regarding survival, while achieving less blood loss and a superior cosmetic outcome. However, longer follow-up is required to confirm these findings.
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Affiliation(s)
- Takayuki Tajima
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Masaya Mukai
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Wataru Noguchi
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Shigeo Higami
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Shuuji Uda
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Souichirou Yamamoto
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Sayuri Hasegawa
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Eiji Nomura
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Sotaro Sadahiro
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Seiei Yasuda
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Hiroyasu Makuuchi
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan ; Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
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Abstract
BACKGROUND Laparoscopic surgical treatment of T4 cancers remains a concern that is mostly associated with technical feasibility, high conversion rate, inadequate oncologic clearance, and surgical outcome. OBJECTIVE The purpose of this work was to evaluate the short- and long-term clinical and oncologic outcomes after laparoscopic and open surgeries for T4 colon cancers. DESIGN This was a retrospective study of patients with T4 colon cancer without metastasis (M0) who had laparoscopic or open surgery from 2003 to 2011. SETTING The study was conducted at a single institution. PATIENTS A total of 83 patients with pT4 colon cancer were included. MAIN OUTCOME MEASURES R0 resection rate, morbidity and mortality within 30 postoperative days, overall survival, and disease-free survival were measured. RESULTS Laparoscopic surgery was performed on 61 and open surgery on 22 patients. The groups were similar in overall staging (p = 0.461), with 35 (42%) of the patients at stage 2 and 48 (58%) at stage 3. A complete R0 resection was achieved in 61 (100%) of the patients who underwent laparoscopic surgery and in 21 (96%) of the patients who underwent open surgery (p = 0.265). The average number of lymph nodes harvested was 21 in the laparoscopic group and 24 in the open group (p = 0.202). Thirty-day morbidity rate was similar between the groups (p = 0.467), and the mortality rate was 0. The length of hospital and postsurgical stay was significantly shorter in the laparoscopic group (p = 0.002 and p = 0.008). The 3-year overall survival rates between the groups were 82% (range, 71%-93%) for patients who underwent laparoscopic surgery and 81% (range, 61%-100%) for those who underwent open surgery (p = 0.525), and disease-free survival was 67% (range, 54%-79%) for laparoscopic surgery and 64% (range, 43%-86%) for open surgery (p = 0.848). The follow-up time was 40 ± 25 in months in the laparoscopic group and 34 ± 26 months in the open surgery group (p = 0.325). LIMITATIONS This was a retrospective study at a single institution. CONCLUSIONS The study shows that laparoscopic surgery is feasible in T4 colon cancers. With comparable clinical and oncologic outcomes, this study suggests that laparoscopy may be considered as an alternative approach for T4 colon cancers with the advantage of faster recovery (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A156).
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Sheng QS, Lin JJ, Chen WB, Liu FL, Xu XM, Hua HJ, Lin CZ, Wang JH. Comparison of hand-assisted laparoscopy with open total colectomy for slow transit constipation: a retrospective study. J Dig Dis 2014; 15:419-24. [PMID: 24798314 DOI: 10.1111/1751-2980.12156] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of hand-assisted laparoscopic colectomy (HALC) and open colectomy (OC) for patients with slow transit constipation (STC). METHODS Data of patients with STC who underwent total colectomy from January 2008 to December 2012 were retrospectively reviewed after clinical evaluation and an exclusion of secondary causes. These patients were further divided into the HALC and OC groups. Patients' outcomes, including intraoperative and postoperative data on their recovery and complications were compared between the two groups. RESULTS A total of 68 patients with STC were finally enrolled in the study, including 32 in the HALC group and 36 in the OC group. The baseline characteristics did not significantly differ between the two groups. Compared with the OC group, patients in the HALC group had a shorter length of incision, a longer operative time and less blood loss volume. There was no conversion to OC for patients undergoing HALC and no intraoperative complications in both groups. Furthermore, after operation, patients in HALC group experienced less pain (3.4 ± 0.7 vs 4.8 ± 1.0), earlier first passage of flatus (58.3 ± 6.3 h vs 73.4 ± 13.0 h), shorter length of postoperative hospital stay (8.8 ± 1.2 days vs 11.3 ± 1.7 days) but higher medical cost (RMB 33 979 ± 3 135 vs RMB 29 828 ± 3 216). The overall postoperative complications and the satisfaction in defecation were comparable in the two groups. CONCLUSION HALC is a safe, minimally invasive and effective surgical alternative for treating STC, which is comparable to OC.
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Affiliation(s)
- Qin Song Sheng
- Department of Colorectal and Anal Surgery, First Affiliated Hospital of the College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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Hand-assisted Laparoscopic Colectomy for Colovesical Fistula Associated With Diverticular Disease. Surg Laparosc Endosc Percutan Tech 2014; 24:251-3. [PMID: 24710221 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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Tajima T, Mukai M, Yamazaki M, Higami S, Yamamoto S, Hasegawa S, Nomura E, Sadahiro S, Yasuda S, Makuuchi H. Comparison of hand-assisted laparoscopic surgery and conventional laparotomy for colorectal cancer: Interim results from a single institution. Oncol Lett 2014; 8:627-632. [PMID: 25013477 PMCID: PMC4081301 DOI: 10.3892/ol.2014.2182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 03/20/2014] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to compare the results of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy (CL) at a single institution in Japan. Of the 212 patients with stage I/II/III colorectal cancer who received a curative resection, 98 patients underwent HALS and 114 patients underwent CL. The clinical background and post-operative management did not differ between the two groups. There were no significant differences in the 3-year relapse-free and 3-year overall survival rates between the HALS and CL groups for the patients in any stage. Blood loss during surgery was 250.1 and 135.5 ml (mean and median; the same hereafter) in stage I patients receiving HALS versus 608.2 and 315.5 ml in stage I CL patients (P=0.006), while it was 277.6 and 146 ml in stage II patients receiving HALS versus 548.6 and 347 ml in stage II CL patients (P=0.004). Post-operative hospital stay was recorded at 16.8 and 15 days in stage III patients receiving HALS versus 23.1 and 21 days in stage III CL patients (P=0.001). There were no significant differences in the operating time or complications between the two groups. These results indicate that the survival rate was comparable for HALS and CL, while HALS caused less surgical stress and achieved a better cosmetic outcome. The results of the final analysis of this cohort are awaited.
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Affiliation(s)
- Takayuki Tajima
- Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan
| | - Masaya Mukai
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Masashi Yamazaki
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Shigeo Higami
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Souichirou Yamamoto
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Sayuri Hasegawa
- Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan
| | - Eiji Nomura
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Sotaro Sadahiro
- Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan
| | - Seiei Yasuda
- Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan
| | - Hiroyasu Makuuchi
- Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan ; Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
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Lorenzon L, La Torre M, Ziparo V, Montebelli F, Mercantini P, Balducci G, Ferri M. Evidence based medicine and surgical approaches for colon cancer: Evidences, benefits and limitations of the laparoscopic vs open resection. World J Gastroenterol 2014; 20:3680-3692. [PMID: 24707154 PMCID: PMC3974538 DOI: 10.3748/wjg.v20.i13.3680] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/26/2013] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To report a meta-analysis of the studies that compared the laparoscopic with the open approach for colon cancer resection.
METHODS: Forty-seven manuscripts were reviewed, 33 of which employed for meta-analysis according to the PRISMA guidelines. The results were differentiated according to the study design (prospective randomized trials vs case-control series) and according to the tumor’s location. Outcome measures included: (1) short-term results (operating times, blood losses, bowel function recovery, post-operative pain, return to the oral intake, complications and hospital stay); (2) oncological adequateness (number of nodes harvested in the surgical specimens); and (3) long-term results (including the survivals’ rates and incidence of incisional hernias) and (4) costs.
RESULTS: Meta-analysis of trials provided evidences in support of the laparoscopic procedures for a several short-term outcomes including: a lower blood loss, an earlier recovery of the bowel function, an earlier return to the oral intake, a shorter hospital stay and a lower morbidity rate. Opposite the operating time has been confirmed shorter in open surgery. The same trend has been reported investigating case-control series and cancer by sites, even though there are some concerns regarding the power of the studies in this latter field due to the small number of trials and the small sample of patients enrolled. The two approaches were comparable regarding the mean number of nodes harvested and long-term results, even though these variables were documented reviewing the literature but were not computable for meta-analysis. The analysis of the costs documented lower costs for the open surgery, however just few studies investigated the incidence of post-operative hernias.
CONCLUSION: Laparoscopy is superior for the majority of short-term results. Future studies should better differentiate these approaches on the basis of tumors’ location and the post-operative hernias.
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Laparoscopy in diverticular disease: Controversies. Best Pract Res Clin Gastroenterol 2014; 28:175-82. [PMID: 24485264 DOI: 10.1016/j.bpg.2013.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 09/17/2013] [Accepted: 11/23/2013] [Indexed: 01/31/2023]
Abstract
A minimally invasive approach to the management of diverticular disease has gained acceptance over the last number of years. Certainly, in the elective setting, laparoscopic sigmoid resection compares favourably with open surgery. The use of laparoscopy in the context of emergency surgery for complicated diverticular disease remains controversial however recent studies have demonstrated a defined role for laparoscopy in the acute setting.
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Ding J, Xia Y, Liao GQ, Zhang ZM, Liu S, Zhang Y, Yan ZS. Hand-assisted laparoscopic surgery versus open surgery for colorectal disease: a systematic review and meta-analysis. Am J Surg 2013; 207:109-19. [PMID: 24119890 DOI: 10.1016/j.amjsurg.2013.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 04/10/2013] [Accepted: 04/29/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Laparoscopic colorectal surgery remains one of the most challenging techniques to learn. METHODS The authors collected studies that have compared hand-assisted laparoscopic surgery (HALS) and open surgery for the treatment of colorectal disease over the past 17 years. Data of interest for HALS and open surgery were subjected to meta-analysis. RESULTS Twelve studies that included 1,362 patients were studied. In total, 2.66% of HALS procedures were converted to laparotomy. Compared with the open surgery group, blood loss, rate of wound infection, and ileus in the HALS group decreased, and incision length, recovery of gastrointestinal function, and hospitalization period were shorter. There were no significant differences in operating time, hospitalization costs, mortality, and complications, including urinary tract infection, pneumonia, and anastomotic leak, between the groups. CONCLUSIONS HALS has the advantages of minimal invasion, lower blood loss, shorter incision length, and faster recovery, and it can shorten the length of hospitalization without an increase in costs. The drawbacks are that a small number of patients who undergo HALS may need to be converted to laparotomy, and the oncologic safety and long-term prognosis are not clear.
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Affiliation(s)
- Jie Ding
- Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital, Guiyang, China; Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Xia
- Department of Stomatology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Guo-qing Liao
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China.
| | - Zhong-min Zhang
- Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital, Guiyang, China.
| | - Sheng Liu
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Zhang
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhong-shu Yan
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China
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Surgical site infection rates: open versus hand-assisted colorectal resections. Tech Coloproctol 2013; 18:381-6. [DOI: 10.1007/s10151-013-1066-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 08/19/2013] [Indexed: 01/09/2023]
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The rate for the use of hand-assisted laparoscopic methods is directly proportional to body mass index. Surg Endosc 2013; 28:108-15. [DOI: 10.1007/s00464-013-3135-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 07/22/2013] [Indexed: 01/10/2023]
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Wang DY, Lin JJ, Xu XM, Liu FL. The role of hand-assisted laparoscopic surgery in total colectomy for colonic inertia: a retrospective study. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:123-7. [PMID: 24020021 PMCID: PMC3764363 DOI: 10.4174/jkss.2013.85.3.123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/27/2013] [Accepted: 06/09/2013] [Indexed: 01/29/2023]
Abstract
Purpose To compare and assess the efficacy, safety and utility of hand-assisted laparoscopic surgery (HALS) with open surgery (OS) in total colectomy with ileorectal for colonic inertia. Methods From January 2001 to February 2012, 56 patients diagnosed with colonic inertia who failed to respond to medical treatments underwent hand-assisted laparoscopic total colectomy with ileorectal anastomosis. Another 68 patients underwent laparotomy. Main parameters such as clinical manifestations, conversion to open procedure, operative time, incision length, pain score, intraoperative blood loss, time to first flatus and hospitalization, early postoperative complications and hospitalization cost were retrospectively analyzed. Postoperative defecating frequencies were followed up in both groups. Results All patients received successful operation, no surgical mortality happened and none of the patients required conversion to an exploratory laparotomy in HALS group. The clinical features, the estimated blood loss, incision length, pain score, first passing flatus time, and postoperative hospitalization time were superior in HALS group (P < 0.05). The early postoperative complications and frequency of defecation were similar. However, the mean operative time was longer and hospitalization cost was higher in HALS group than those in OS group (P < 0.05). Conclusion HALS total colectomy can be a safe and efficient technique in the treatment of colonic inertia. HALS can result in a better cosmetic result and a quicker postoperative recovery, but requires higher direct cost.
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Affiliation(s)
- Dan Yang Wang
- Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
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Shussman N, Brown MR, Johnson MC, Da Silva G, Wexner SD, Weiss EG. Does nasogastric tube decompression get used less often with laparoscopic and hand-assisted compared with open colectomy? Surg Endosc 2013; 27:4564-8. [PMID: 23955728 DOI: 10.1007/s00464-013-3124-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 07/17/2013] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Laparoscopic surgery is associated with well-known benefits, one of which is earlier return of bowel function. Since the laparoscopic approach to colon resections was introduced in the early 1990s, it has become the standard of care. Hand-assisted laparoscopic surgery (HALS) is a surgical approach in which dissection is facilitated by the surgeon's hand within the abdominal cavity during laparoscopy. The purpose of this study was to compare the incidence of postoperative ileus and the need for nasogastric tube (NGT) decompression in patients undergoing elective colon resections. METHODS AND PROCEDURES Following institutional review board approval, we performed a retrospective review of a prospectively collected database. Included were patients who underwent elective left-sided large bowel resections between 2009 and 2012. Exclusion criteria were urgent operation, stoma creation, ASA IV classification, NGT left in place at the end of surgery, and postoperative anastomotic leakage. Patients were divided into three groups: laparoscopic surgery, HALS, and open surgery. We evaluated the incidence of postoperative ileus and the use of nasogastric decompression in each group. RESULTS A total of 243 patients were included in this study; 73 patients underwent open surgery, 89 patients underwent HALS, and 81 patients underwent laparoscopic surgery. The proportion of patients who needed postoperative nasogastric decompression was significantly reduced in patients undergoing laparoscopic surgery (3.7%) or HALS (4.5%) compared with those who underwent open resection (17.8%). The time from surgery to first flatus and first bowel movement, the time to tolerate solid diet, and the total length of postoperative hospital stay also were all significantly reduced in the laparoscopic and HALS groups compared with the open surgery group. There were no significant differences in any of these measures between the laparoscopic group and the hand-assisted group. CONCLUSIONS Like laparoscopy, HALS is associated with less postoperative ileus and necessitates less NGT decompression than does open surgery.
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Affiliation(s)
- Noam Shussman
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA,
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Abstract
BACKGROUND A PubMed search of the biomedical literature was carried out to systematically review the role of laparoscopy in colonic diverticular disease. All original reports comparing elective laparoscopic, hand-assisted, and open colon resection for diverticular disease of the colon, as well as original reports evaluating outcomes after laparoscopic lavage for acute diverticulitis, were considered. Of the 21 articles chosen for final review, nine evaluated laparoscopic versus open elective resection, six compared hand-assisted colon resection versus conventional laparoscopic resection, and six considered laparoscopic lavage. Five were randomized controlled trials. RESULTS Elective laparoscopic colon resection for diverticular disease is associated with increased operative time, decreased postoperative pain, fewer postoperative complications, less paralytic ileus, and shorter hospital stay compared to open colectomy. Laparoscopic lavage and drainage appears to be a safe and effective therapy for selected patients with complicated diverticulitis. CONCLUSIONS Elective laparoscopic colectomy for diverticular disease is associated with decreased postoperative morbidity compared to open colectomy, leading to shorter hospital stay and fewer costs. Laparoscopic lavage has an increasing but poorly defined role in complicated diverticulitis.
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Meng WJ, Wang ZQ, Zhou ZG. Hand-assisted laparoscopic right colectomy: a consideration of hand-device placement and trocar arrangement. Colorectal Dis 2013; 15:910-1. [PMID: 23672571 DOI: 10.1111/codi.12283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/26/2013] [Indexed: 12/16/2022]
Affiliation(s)
- W.-J. Meng
- Department of Gastrointestinal Surgery; West China Hospital; Sichuan University; Chengdu; 610041; China
| | - Z.-Q. Wang
- Department of Gastrointestinal Surgery; West China Hospital; Sichuan University; Chengdu; 610041; China
| | - Z.-G. Zhou
- Department of Gastrointestinal Surgery; West China Hospital; Sichuan University; Chengdu; 610041; China
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Sim JH, Jung EJ, Ryu CG, Paik JH, Kim G, Kim SR, Hwang DY. Short-term Outcomes of Hand-Assisted Laparoscopic Surgery vs. Open Surgery on Right Colon Cancer: A Case-Controlled Study. Ann Coloproctol 2013; 29:72-6. [PMID: 23700574 PMCID: PMC3659246 DOI: 10.3393/ac.2013.29.2.72] [Citation(s) in RCA: 12] [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: 03/19/2013] [Accepted: 04/01/2013] [Indexed: 11/05/2022] Open
Abstract
Purpose This study was designed to evaluate short-term clinical outcomes by comparing hand-assisted laparoscopic surgery with open surgery for right colon cancer. Methods Sixteen patients who underwent a hand-assisted laparoscopic right hemicolectomy (HAL-RHC group) and 33 patients who underwent a conventional open right hemicolectomy (open group) during the same period were enrolled in this study with a case-controlled design. Results The operation time was 217 minutes in the HAL-RHC group and 213 minutes in the open group (P = 0.389). The numbers of retrieved lymph nodes were similar between the two groups (31 in the HAL-RHC group and 36 in the open group, P = 0.737). Also, there were no significant difference in the incidence of immediate postoperative leukocytosis, the administration of additional pain killers, and the postoperative recovery parameters. First flatus was shown on postoperative days 3.5 in the HAL-RHC group and 3.4 in the open group (P = 0.486). Drinking water and soft diet were started on postoperative days 4.8 and 5.9, respectively, in the HAL-RHC group and similarly 4.6 and 5.6 in the open group (P = 0.402 and P = 0.551). The duration of hospital stay was shorter in the HAL-RHC group than in the open group (10.3 days vs. 13.5 days, P = 0.048). No significant difference in the complication rates was shown between the two groups, and no postoperative mortality was encountered in either group. Conclusion The patients with right colon cancer in the HAL-RHC group had similar pathologic and postoperative recovery parameters to those of the patients in the open group. The patients in the HAL-RHC group had shorter hospital stays than those in the open group. Therefore, hand-assisted laparoscopic right hemicolectomy for right-sided colon cancer is feasible.
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Affiliation(s)
- Jae-Hoon Sim
- Department of Surgery, Colorectal Cancer Center, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Nam SE, Jung EJ, Ryu CG, Paik JH, Hwang DY. Feasibility of hand-assisted laparoscopic surgery as compared to open surgery for sigmoid colon cancer: a case-controlled study. Ann Coloproctol 2013; 29:17-21. [PMID: 23586010 PMCID: PMC3624981 DOI: 10.3393/ac.2013.29.1.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 02/15/2013] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate short-term clinical outcomes by comparing hand-assisted laparoscopic surgery (HALS) with open surgery for sigmoid colon cancer. METHODS Twenty-six patients who underwent a hand-assisted laparoscopic anterior resection (HAL-AR group) and 52 patients who underwent a conventional open anterior resection during the same period were enrolled (open group) in this study with a case-controlled design. RESULTS Pathologic parameters were similar between the two groups. The incidences of immediate postoperative leukocytosis were 38.5% in the HAL-AR group and 69.2% in the open group (P = 0.009). There were no significant differences between the two groups as to leukocyte count, hemoglobin, and hematocrits (P = 0.758, P = 0.383, and P = 0.285, respectively). Of the postoperative recovery indicators, first flatus, sips of water and soft diet started on postoperative days 3, 5, 7 in the HALS group and on days 4, 5, 6 in the open group showed statistical significance (P = 0.021, P = 0.259, and P = 0.174, respectively). Administration of additional pain killers was needed for 1.2 days in the HAL-AR group and 2.4 days in the open group (P = 0.002). No significant differences in the durations of hospital stay and the rates of postoperative complications were noted, and no postoperative mortality was encountered in either group. CONCLUSION The patients with sigmoid colon cancer who underwent a HAL-AR had a lower incidence of postoperative leukocytosis, less administration of pain killers, and faster first flatus than those who underwent open surgery. Clinical outcomes for patients' recovery and pathology status were similar between the two groups. Therefore, a HAL-AR for sigmoid colon cancer is feasible and has the same benefit as minimally invasive surgery.
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Affiliation(s)
- Sang Eun Nam
- Department of Surgery, Colorectal Cancer Center, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Yang TX, Chua TC. Single-incision laparoscopic colectomy versus conventional multiport laparoscopic colectomy: a meta-analysis of comparative studies. Int J Colorectal Dis 2013; 28:89-101. [PMID: 22828958 DOI: 10.1007/s00384-012-1537-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2012] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study aimed to compare single-incision laparoscopic colectomy (SILC) to conventional multiport laparoscopic colectomy (MLC). BACKGROUND Single-incision laparoscopic surgery (SILS) is a minimally invasive technique being recently applied to colorectal surgery. A number of studies comparing SILC to conventional MLC have recently been published. METHODS A literature search of PubMed and MEDLINE databases for studies comparing SILC to conventional MLC was conducted. The primary outcome measures for meta-analysis were postoperative complications, length of stay, and operative time. Secondary outcome measures were incision length, estimated blood loss, and number of lymph nodes harvested. RESULTS Fifteen studies comparing 467 patients undergoing SILC to 539 patients undergoing conventional MLC were reviewed and the data pooled for analysis. Patients undergoing SILC had a shorter length of stay (pooled weighted mean difference (WMD) = -0.68; 95 % CI = -1.20 to -0.16; p = 0.0099), shorter incision length (pooled WMD = -1.37; 95 % CI = -2.74 to 0.000199; p = 0.05), less estimated blood loss (pooled WMD = -20.25; 95 % CI = -39.25 to -1.24; p = 0.037), and more lymph nodes harvested (pooled WMD = 1.75; 95 % CI = 0.12 to 3.38; p = 0.035), while there was no significant difference in the number of postoperative complications (pooled odds ratio = 0.83; 95 % CI = 0.57 to 1.20; p = 0.33) or operative time (pooled WMD = 5.06; 95 % CI = -2.91 to 13.03; p = 0.21). CONCLUSION SILC appears to have comparable results to conventional MLC in the hands of experienced surgeons. Prospective randomized trials are necessary to define the relative benefits of one procedure over the other.
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Affiliation(s)
- Timothy X Yang
- Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Kogarah, Sydney, NSW 2217, Australia
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Orcutt ST, Marshall CL, Balentine CJ, Robinson CN, Anaya DA, Artinyan A, Berger DH, Albo D. Hand-assisted laparoscopy leads to efficient colorectal cancer surgery. J Surg Res 2012; 177:e53-8. [PMID: 22841382 DOI: 10.1016/j.jss.2012.02.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/16/2012] [Accepted: 02/22/2012] [Indexed: 12/21/2022]
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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: 1.5] [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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Yang TX, Chua TC. Single-incision laparoscopic colectomy versus conventional multiport laparoscopic colectomy: a meta-analysis of comparative studies. Int J Colorectal Dis 2012. [PMID: 22828958 DOI: 10.1007/s00384-012-1537-0.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
OBJECTIVE This study aimed to compare single-incision laparoscopic colectomy (SILC) to conventional multiport laparoscopic colectomy (MLC). BACKGROUND Single-incision laparoscopic surgery (SILS) is a minimally invasive technique being recently applied to colorectal surgery. A number of studies comparing SILC to conventional MLC have recently been published. METHODS A literature search of PubMed and MEDLINE databases for studies comparing SILC to conventional MLC was conducted. The primary outcome measures for meta-analysis were postoperative complications, length of stay, and operative time. Secondary outcome measures were incision length, estimated blood loss, and number of lymph nodes harvested. RESULTS Fifteen studies comparing 467 patients undergoing SILC to 539 patients undergoing conventional MLC were reviewed and the data pooled for analysis. Patients undergoing SILC had a shorter length of stay (pooled weighted mean difference (WMD) = -0.68; 95 % CI = -1.20 to -0.16; p = 0.0099), shorter incision length (pooled WMD = -1.37; 95 % CI = -2.74 to 0.000199; p = 0.05), less estimated blood loss (pooled WMD = -20.25; 95 % CI = -39.25 to -1.24; p = 0.037), and more lymph nodes harvested (pooled WMD = 1.75; 95 % CI = 0.12 to 3.38; p = 0.035), while there was no significant difference in the number of postoperative complications (pooled odds ratio = 0.83; 95 % CI = 0.57 to 1.20; p = 0.33) or operative time (pooled WMD = 5.06; 95 % CI = -2.91 to 13.03; p = 0.21). CONCLUSION SILC appears to have comparable results to conventional MLC in the hands of experienced surgeons. Prospective randomized trials are necessary to define the relative benefits of one procedure over the other.
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Affiliation(s)
- Timothy X Yang
- Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Kogarah, Sydney, NSW 2217, Australia
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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: 3.5] [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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42
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Orcutt ST, Marshall CL, Robinson CN, Balentine CJ, Anaya DA, Artinyan A, Awad SS, Berger DH, Albo D. Minimally invasive surgery in colon cancer patients leads to improved short-term outcomes and excellent oncologic results. Am J Surg 2011; 202:528-31. [DOI: 10.1016/j.amjsurg.2011.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 06/27/2011] [Accepted: 06/27/2011] [Indexed: 11/17/2022]
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44
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Zhou NX, Chen JZ, Liu Q, Zhang X, Wang Z, Ren S, Chen XF. Outcomes of pancreatoduodenectomy with robotic surgery versus open surgery. Int J Med Robot 2011; 7:131-7. [PMID: 21412963 DOI: 10.1002/rcs.380] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2011] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pancreatoduodenectomy (PD) for pancreatic cancer is very challenging to many surgeons. Information regarding the advantage of using the Da Vinci robotic system over conventional open surgery for PD is rare. Therefore, a comparison of the outcomes of PD performed using the Da Vinci robotic system with outcomes using open surgery was conducted. METHODS Between January 2009 and December 2009 sixteen patients underwent PD, eight patients receiving robot-assisted surgery using the Da Vinci surgical robotic system (Group I) and eight being treated using conventional open surgery (Group II). RESULTS There was no significant difference in radical resection (R0) rate between the two groups, 87.5% vs 100%, P = 0.05. The operative time in group I was longer than in group II, 718 ± 186 vs 420 ± 127 min, P = 0.011, while the surgical blood loss in group I was less than in group II, 153 ± 43 vs 210 ± 53 mL, P = 0.045. The length of bed time and hospital stay after surgery in group I were shorter than in group II, 27.5 ± 7.1 vs 96 ± 18.1 h, P = 0.000; 16.4 ± 4.1 vs 24.3 ± 7.1 days, P = 0.04, respectively). Complication rate of group I was lower than that of group II, 25% vs 75%, P = 0.05. CONCLUSION It is feasible and safe to perform PD using the Da Vinci robot-assisted surgical system; patients recovered faster postoperatively with less blood loss during surgery.
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Affiliation(s)
- Ning-xin Zhou
- Institute of Hepatobiliary Gastrointestinal Disease, General Hospital of PLA Second Artillery, No. 16 Xinjiekouwai Avenue, Xicheng District, Beijing, China.
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45
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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: 1.6] [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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46
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Orenstein SB, Elliott HL, Reines LA, Novitsky YW. Advantages of the hand-assisted versus the open approach to elective colectomies. Surg Endosc 2010; 25:1364-8. [PMID: 20953800 DOI: 10.1007/s00464-010-1368-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 09/04/2010] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hand-assisted laparoscopic colectomy has been introduced as an alternative to standard laparoscopy. However, to date, it has not been established whether intraabdominal placement of a hand abrogates the benefits of minimally invasive techniques. The authors hypothesized that the hand-assisted approach confers advantages of minimal access surgery over traditional open colectomy. METHODS Consecutive patients undergoing elective open (OC) and hand-assisted (HALC) colon resections were retrospectively reviewed. Open colectomies performed by the laparoscopic surgeons were excluded. Outcome measures included patient demographics, operative time, perioperative complications, operative and total hospital charges, and length of hospital stay. Statistical analysis was performed with a p value less than 0.05 considered significant. RESULTS The study identified and reviewed 323 consecutive elective OCs and 66 consecutive elective HALCs. Of these, 228 OCs (70.6%) and 52 HALCs (78.8%) were left-sided. The two groups were similar in age, sex, and body mass index (BMI). The mean operative time was longer in the HALC group (202 vs 160 min; p<0.05). No major intraoperative complications occurred in either group, and no conversions from HALC to OC were performed. Postoperatively, 14 OC patients (3.8%) required blood transfusion versus no HALC patients. The rate of wound infections also was higher in the OC group (3.4%, n=11) than in the HALC group (1.5%, n=1) (p=0.04). All seven mortalities (2.3%) occurred in the OC group. The median hospital stay was significantly shorter in the HALC group (5.3 vs 8.4 days; p<0.001). The total hospital charges were significantly lower in the HALC group ($24,132 vs $33,150; p<0.001). CONCLUSION Hand-assisted laparoscopic colectomy is a safe alternative to traditional open colonic resection. In this series, it was associated with decreased postoperative morbidity and mortality. Despite longer operative times, the use of the hand-assisted techniques significantly reduced the hospital stay and decreased the total hospital charges. Overall, in the elective setting, hand-assisted laparoscopic colectomy appears to be advantageous over the traditional open colectomy.
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Affiliation(s)
- Sean B Orenstein
- Department of Surgery, University of Connecticut Health Center, 263 Farmington Avenue, MC 3955, Farmington, CT 06030, USA
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47
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Ozturk E, da Luz Moreira A, Vogel JD. Hand-assisted laparoscopic colectomy: the learning curve is for operative speed, not for quality. Colorectal Dis 2010; 12:e304-9. [PMID: 20070328 DOI: 10.1111/j.1463-1318.2010.02205.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM We aimed to define the learning curve for hand-assisted laparoscopic colectomy (HALC). METHOD A retrospective analysis of prospectively recorded data was performed. Consecutive segmental and total HALC performed by a single surgeon with no prior HALC experience was included. Operative time and quality-related outcomes, including conversions, operative and postoperative complications, length of stay, reoperations and readmissions were compared for consecutive cohorts of 25 HALC. A subgroup analysis of right, left, total and proctocolectomy performed in each cohort of 25 HALC was also performed. RESULTS From December 2005 to February 2009, 200 HALC were performed. When evaluated in cohorts of 25 consecutive cases, operative times (155-206 min), operative complications (4-12%), postoperative complications (8-36%), length of stay (4-5 days), reoperations (0-8%) and readmissions (0-16%) were similar. In the subgroup analysis, there were no changes in the quality-related measures for any colectomy type or the operative time for right and proctocolectomy as experience was gained. Operative time decreased for left (183-127 min) and total HALC (259-218 min) after experience with 50 cases (P < 0.05). CONCLUSION HALC operative times decreased with surgeon experience. For quality-related outcomes, there was no learning curve for HALC.
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Affiliation(s)
- E Ozturk
- Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Liu FL, Lin JJ, Ye F, Teng LS. Hand-assisted laparoscopic surgery versus the open approach in curative resection of rectal cancer. J Int Med Res 2010; 38:916-22. [PMID: 20819427 DOI: 10.1177/147323001003800317] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This prospective, randomized study compared the outcomes of hand-assisted laparoscopic surgery (HALS) with open surgery for the resection of rectal cancer. The main outcome measures were procedure time, blood loss, post-operative pain, time to oral intake, return of bowel function, length of hospital stay, morbidity and functional recovery. Patients in each group were similar with regard to general status, procedure types and the histopathological features of tumours. Procedure times were significantly longer with HALS versus open surgery. Analgesic requirements, surgical blood loss, time to first passing flatus, time to first oral fluids and post-operative hospital stay length were all significantly shorter in the HALS group. At a median follow-up of 16.3 months, local recurrence of tumour was not observed in either group. In this study, the HALS approach for curative resection of rectal cancer was safe and effective and may offer several potential advantages to patients in their post-operative recovery.
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Affiliation(s)
- F L Liu
- Department of Anal, Rectal and Colonic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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DeSouza A, Domajnko B, Park J, Marecik S, Prasad L, Abcarian H. Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy? Surg Endosc 2010; 25:1031-6. [PMID: 20737171 DOI: 10.1007/s00464-010-1309-2] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 07/26/2010] [Indexed: 12/14/2022]
Affiliation(s)
- Ashwin DeSouza
- Division of Colon and Rectal Surgery, University of Illinois at Chicago College of Medicine, 840 S. Wood St., Suite 518(E) CSB, Chicago, IL 60612, USA.
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DeSouza A, Domajnko B, Park J, Marecik S, Prasad L, Abcarian H. Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy? Surg Endosc 2010. [PMID: 20737171 DOI: 10.1007/s00464-010-1309-2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Minimally invasive surgery is associated with smaller surgical incisions than those of traditional midline laparotomy. However, most colorectal resections and all hand-assisted procedures require an incision either for specimen retrieval or insertion of the hand-assist device. The ideal site of this incision has not been evaluated with respect to the incidence of incisional hernia. This study compares the rates of incisional hernia associated with a standard midline laparotomy, a midline incision of reduced length, and a Pfannenstiel incision. METHODS From March 2004 to July 2007, 512 consecutive patients were identified from a prospectively maintained database according to predefined inclusion and exclusion criteria. Patients were divided into three groups depending on the type of incision (open, midline, and Pfannenstiel). Demographic variables, rate of incisional hernia, and risk factors for hernia were compared among the groups. RESULTS There were 142, 231, and 139 patients in the open, midline, and Pfannenstiel groups, respectively. All three groups were comparable with respect to age, gender, steroid use, diabetes, number of patients with malignancy, and duration of follow-up. The Pfannenstiel group had a higher mean BMI (p = 0.015) and the open group had a higher rate of wound infection (28.2%) compared to the other groups. Incidence of incisional hernia was similar for the open and midline groups (19.7 and 16%, p = 0.36). At a mean follow-up of 17.5 months, not a single patient with a Pfannenstiel incision developed an incisional hernia (p < 0.001). BMI (p = 0.019), follow-up (p < 0.001), and Pfannenstiel incision (p < 0.001) were found to be predictors (protectors) of incisional hernia on multivariate analysis. CONCLUSION A Pfannenstiel incision is associated with the lowest rate of incisional hernia and should be the incision of choice for hand assistance and specimen extraction in minimally invasive colorectal resections wherever applicable.
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Affiliation(s)
- Ashwin DeSouza
- Division of Colon and Rectal Surgery, University of Illinois at Chicago College of Medicine, 840 S. Wood St., Suite 518(E) CSB, Chicago, IL 60612, USA.
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