Case-matched Study of Short-term Outcomes and Cost Analysis Between Simplified Hand-assisted Laparoscopic (Totally Three-port Approach) and Open Surgery

Natthawut Phothong, Thawatchai Akaraviputh, Vitoon Chinswangwatanakul, PhD, Voraboot Taweerutchana, Asada Metasate, Jirawat Swangsri, Thanyadej Nimmanwudipong, Auttaporn Trakarnsanga. 1 Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. 2 Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand..

INTRODUCTION: Hand-assisted laparoscopic colectomy (HALC) provides the benefit of shorter operative time and less conversion rate compared with standard laparoscopic surgery. In addition, the potential advantages of minimally invasive surgery in HALC are still retained when compared to open colectomy (OC). However, an assistant is still required in order to complete this procedure, especially for the operation of left-sided lesions. In our center, we performed HALC by using totally three-port approach (One of hand-, operative- and camera-port). The operation can be accomplished by performing surgery with a camera holder.The purpose of this study is to demonstrate the potential benefits of this technique.

METHODS: A retrospective review of prospective maintained database of 100 patients with sigmoid and recto-sigmoid cancer at Department of Surgery, Siriraj Hospital was performed. Fifty of three-port HALC were case matched with 1:1 with patients who underwent OC. Short-term outcomes and Costs of treatment were collected and analyzed.

RESULTS: One hundred patients with sigmoid and recto-sigmoid cancer (50 three-port HALC and 50 OC) were included. There were no differences of age, gender, body mass index, ASA score, Charlson comorbidity index score, and previous abdominal surgery between two groups. The three-port HALC group patients had significantly less blood loss (69ml vs. 177ml, p< 0.001), faster time to regular diet (64.6hr vs. 97.6hr, p< 0.001), less pain score at first post-operative day (4.3 vs. 5.3, p= 0.003), shorter hospital stay (7.5days vs. 11.1days, p< 0.001), and lower surgical site infection (0% vs. 12%, p= 0.03). Operative time and number of harvested lymph nodes had no significant differences between two procedures. The operative cost was significantly higher in HALC group (US $1025 vs. $636, p< 0.001). However, total cost was not significantly different between HALC and OC (US $3220 vs. $2765, respectively, p=0.11).

CONCLUSION: This study demonstrated that simplified three-port HALC could be successfully and safely performed and provided several short-term benefits including less blood loss, faster time to regular diet, less pain score at first post-operative day, shorter hospital stay, and lower surgical site infection when compared to OC. In addition, the operative time and total cost were not significantly different between two groups.

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