Utility and short-term outcomes of hand-assisted laparoscopic colorectal surgery

A single-institution experience in 1103 patients

Robert R. Cima, Rajesh Pendlimari, Stefan D. Holubar, Jirawat Pattana-Arun, David Larson, Eric Dozois, Bruce G. Wolff, John H. Pemberton

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

BACKGROUND: Despite its introduction in 1991, laparoscopic colectomy is performed in < 10% of United States patients requiring colectomy. Laparoscopic colectomy is avoided principally because of its technical difficulty, steep learning curve, and increased operative times. Hand-assisted laparoscopic colectomy is an alternative technique that addresses these problems while preserving the short-term benefits of laparoscopic colectomy. OBJECTIVE: To describe the utility and short-term outcomes, we evaluated 1103 patients who underwent hand-assisted laparoscopic colorectal resections over a 5-year period. DESIGN: This study was a retrospective analysis of prospectively collected data. SETTINGS: The setting was a single tertiary care institution. PATIENTS: A total of 1103 consecutive hand-assiste laparoscopic colorectal resections from 2004 to 2009 were identified using a prospectively maintained database. MAIN OUTCOME MEASURES: Demographics, perioperative variables, and 30-day outcomes were reported. Data are presented as frequency (proportion) or median (interquartile range). RESULTS: A total of 1103 hand-assisted laparoscopic colorectal resections were documented. Median age of patients was 55 years; 47% were women, and median body mass index was 26.5 (range, 23-34) kg/m 2. Diagnoses included inflammatory bowel disease (35%), colorectal cancer (31%), diverticular disease (23%), and "other" (11%). Forty-two percent of patients had prior abdominal surgery. Segmental colectomies were performed in 533 (48%) patients, proctocolectomy with ileal pouch-anal anastomosis in 229 (21%), proctocolectomy with end ileostomy in 114 (10%), and "other" in 227 (21%). The conversion rate was 9%. Overall median operative time was 201 (range, 145-269) minutes, and the median postoperative length of stay was 5 (range, 4-7) days. Postoperative complications occurred in 27% and readmissions in 7%; mortality was 0.3%. LIMITATIONS: This was a single institutional retrospective study. CONCLUSIONS: Hand-assisted laparoscopic colorectal resection can be performed for numerous indications. It preserves nearly all the benefits of laparoscopic colectomy reported in the literature. With experience, it is associated with significantly reduced operative times. Wider adoption of hand-assisted laparoscopic colorectal surgery would increase the number of patients benefiting from minimal access colorectal surgery.

Original languageEnglish (US)
Pages (from-to)1076-1081
Number of pages6
JournalDiseases of the Colon and Rectum
Volume54
Issue number9
DOIs
StatePublished - Sep 2011

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Hand-Assisted Laparoscopy
Colorectal Surgery
Colectomy
Hand
Operative Time
Colonic Pouches
Ileostomy
Learning Curve
Tertiary Healthcare
Inflammatory Bowel Diseases
Colorectal Neoplasms
Length of Stay
Body Mass Index
Retrospective Studies
Demography
Databases
Mortality

Keywords

  • Hand-assisted laparoscopic surgery
  • Laparoscopic colectomy
  • Short-term outcomes

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Utility and short-term outcomes of hand-assisted laparoscopic colorectal surgery : A single-institution experience in 1103 patients. / Cima, Robert R.; Pendlimari, Rajesh; Holubar, Stefan D.; Pattana-Arun, Jirawat; Larson, David; Dozois, Eric; Wolff, Bruce G.; Pemberton, John H.

In: Diseases of the Colon and Rectum, Vol. 54, No. 9, 09.2011, p. 1076-1081.

Research output: Contribution to journalArticle

Cima, Robert R. ; Pendlimari, Rajesh ; Holubar, Stefan D. ; Pattana-Arun, Jirawat ; Larson, David ; Dozois, Eric ; Wolff, Bruce G. ; Pemberton, John H. / Utility and short-term outcomes of hand-assisted laparoscopic colorectal surgery : A single-institution experience in 1103 patients. In: Diseases of the Colon and Rectum. 2011 ; Vol. 54, No. 9. pp. 1076-1081.
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AU - Pattana-Arun, Jirawat

AU - Larson, David

AU - Dozois, Eric

AU - Wolff, Bruce G.

AU - Pemberton, John H.

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N2 - BACKGROUND: Despite its introduction in 1991, laparoscopic colectomy is performed in < 10% of United States patients requiring colectomy. Laparoscopic colectomy is avoided principally because of its technical difficulty, steep learning curve, and increased operative times. Hand-assisted laparoscopic colectomy is an alternative technique that addresses these problems while preserving the short-term benefits of laparoscopic colectomy. OBJECTIVE: To describe the utility and short-term outcomes, we evaluated 1103 patients who underwent hand-assisted laparoscopic colorectal resections over a 5-year period. DESIGN: This study was a retrospective analysis of prospectively collected data. SETTINGS: The setting was a single tertiary care institution. PATIENTS: A total of 1103 consecutive hand-assiste laparoscopic colorectal resections from 2004 to 2009 were identified using a prospectively maintained database. MAIN OUTCOME MEASURES: Demographics, perioperative variables, and 30-day outcomes were reported. Data are presented as frequency (proportion) or median (interquartile range). RESULTS: A total of 1103 hand-assisted laparoscopic colorectal resections were documented. Median age of patients was 55 years; 47% were women, and median body mass index was 26.5 (range, 23-34) kg/m 2. Diagnoses included inflammatory bowel disease (35%), colorectal cancer (31%), diverticular disease (23%), and "other" (11%). Forty-two percent of patients had prior abdominal surgery. Segmental colectomies were performed in 533 (48%) patients, proctocolectomy with ileal pouch-anal anastomosis in 229 (21%), proctocolectomy with end ileostomy in 114 (10%), and "other" in 227 (21%). The conversion rate was 9%. Overall median operative time was 201 (range, 145-269) minutes, and the median postoperative length of stay was 5 (range, 4-7) days. Postoperative complications occurred in 27% and readmissions in 7%; mortality was 0.3%. LIMITATIONS: This was a single institutional retrospective study. CONCLUSIONS: Hand-assisted laparoscopic colorectal resection can be performed for numerous indications. It preserves nearly all the benefits of laparoscopic colectomy reported in the literature. With experience, it is associated with significantly reduced operative times. Wider adoption of hand-assisted laparoscopic colorectal surgery would increase the number of patients benefiting from minimal access colorectal surgery.

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