Background: Hand-assisted laparoscopic colon resection (HALCR) is an approach which may lessen the need for conversion, shorten operative time, and decrease disposable costs while maintaining the benefits of minimally-invasive surgery. The aim of this study was to compare the clinical outcomes of patients who underwent colon or rectal resections for cancer/adenoma, diverticulitis, or inflammatory bowel disease (IBD) by either standard laparoscopy (SL) or HALCR. Methods: After IRB approval, all HALCR cases performed between 2004 and 2007 were identified, and matched to SL colon resections (SLCR) based on age, gender, diagnosis, BMI and ASA classification. The cases were identified from a prospectively collected database of colorectal surgical patients. We retrospectively reviewed the database and individual patient charts and compared patient characteristics, intraoperative findings, and postoperative course. Further subgroup analysis of patients with complicated diverticulitis and patients with morbid obesity was also performed. Statistical analysis was performed using the SPSSÒ 15 software package. Results: 160 patients were identified who fit our inclusion criteria. Of these, 80 underwent SLCR and 80 underwent HALCR. The patient demographic were equivalent in both groups. The conversion rate (13 vs 46%, p< 0.05) and operative time (174 vs 226 minutes, p=< 0.05) were significantly higher in the SLCR compared to the HALCR, respectively. All other variables including length of stay, length of incision, time to first bowel movement, time to first meal, and postoperative complications were not significantly different between the two groups. Among patients with complicated diverticulitis, conversion rates (11 vs. 30%, p< 0.05) were significantly lower in the HALCR group compared to the SLCR group, respectively. There was no significant difference in conversion rates among patients based on BMI. Conclusions: HALCR is an option which decreases conversion rates and operative time when compared to SLCR in patients with cancer, diverticulitis, or IBD, while preserving the postoperative benefits of laparoscopic surgery. This technique may be the minimally invasive procedure of choice, particularly in the subgroup of patients with complicated diverticulitis.
Program Number: P132