• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES Top 21 MIS Procedures
    • SAGES Pearls
    • SAGES Flexible Endoscopy 101
    • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Hand-assisted Laparoscopic Versus Open Colectomy An Assessment From NSQIP Procedure-targeted Cohort

Cigdem Benlice, MD1, Meagan Costedio, MD1, Luca Stocchi, MD1, Xiaobo Liu, MS2, Maher A Abbas, MD3, Emre Gorgun, MD1. 1Cleveland Clinic, Digestive Disease Institute, Department of Colorectal Surgery, 2Cleveland Clinic, Department of Quantitative Health Sciences, 3Cleveland Clinic Abu Dhabi, Digestive Disease Institute

Introduction: Hand-assisted laparoscopic surgery (HALS) has gained acceptance as a viable option for patients undergoing colorectal resection. However the data remains limited on the potential advantages of HALS compared to open surgery. The purpose of this study was to compare the perioperative outcomes of patients who underwent colorectal resection with HALS or open surgery.

Methods: A database review was conducted using the 2012 colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).Patients were classified into two groups according to the final surgical approach: HALS vs. Open (planned). Groups were matched (1:1) based on NSQIP-derived morbidity and mortality probabilities. Multivariate logistic regression analysis was used for group comparison.

Results: 3506 cases were reviewed (1753 patients in each group). Operative time was significantly longer in the HALS group [163 (36-684) vs. 141 (30-1006) minutes, p<0.001]. Length of hospital stay was longer in the Open group [6 (1-112) days vs. 5 (1-79), p<0.001]. After adjustment for the listed comorbid conditions using logistic regression, overall morbidity and ileus rates were significantly higher in the Open group [(22.7% vs. 25.9%, OR: 1.5, p=0.0001) and (10.5% vs. 14.3%, OR: 1.3, p=0.02), respectively]. Superficial and deep surgical site infection rates were comparable between the 2 groups (p=0.08 and 0.13, respectively). Multivariable analysis showed that the following independent risk factors were associated with postoperative morbidity: open surgery, ASA class III and IV, disseminated cancer, preoperative steroid use, and presence of bleeding disorder (Table).

Conclusion: NSQIP targeted data demonstrated several short-term advantages to HALS compared to open colorectal resection including a shorter length of stay, less complications, and lower rate of ileus. Further adoption of the HALS technique will have significant positive impact on short-term outcomes following colectomy.

Table. Independent risk factors associated with postoperative morbidity

Factor Odds Ratio 95% CI P-value
Open vs. HALS 1.457

1.205-1.762

0.0001
Disseminated cancer (Yes vs. No) 1.744

1.285- 2.368

0.0004
Steroid use (Yes vs. No) 1.582

1.16- 2.156

0.0037
Bleeding disorder (Yes vs. No) 1.571

1.059-2.331

0.0249
ASA <.0001
II vs. I 1.376

0.713-2.658

0.3414
III vs. I 2.118

1.087-4.125

0.0273
IV vs. I 2.403

1.093-5.282

0.0291

HALS: Hand-Assisted Laparoscopic Colectomy, CI: Confidence Interval, ASA: American Society of Anesthesiologists.

60

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2024 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons