PURPOSE: This study was designed to compare short-term outcomes after hand-assisted laparoscopic vs. straight laparoscopic total proctocolectomy with ileoanal pullthrough. METHODS: A retrospective study was performed on all TPC IPAA at a single institution by a single surgeon between July 2002 to July 2008. The study was powered to detect a 30-minute reduction in operative time between hand-assisted laparoscopic and straight laparoscopic groups. RESULTS: There were 9 hand-assisted patients and 47 straight laparoscopic patients. There were no differences in the patient age, sex, previous surgery, and procedures performed between the hand-assisted and straight laparoscopic groups. Resident participation in the procedures was similar for both groups. The mean operative time (in minutes) was significantly less in the hand-assisted laparoscopic group versus the straight laparoscopic group (175 +/- 60 vs. 370 +/- 120). There were no apparent differences in the time to return of bowel function, tolerance of diet, narcotic usage, postoperative pain scores or length of stay, between the hand-assisted laparoscopic and straight laparoscopic groups. There was 0 conversion in the hand-assisted laparoscopic group and 4 (9 percent) in the straight laparoscopic group. Complications were less in the hand assisted group than the straight laparoscopic group (0 vs 5 ). The number of diversion were similar in both groups (6 vs 37) CONCLUSIONS: In this prospective, randomized study, hand-assisted laparoscopic colorectal surgery resulted in significantly shorter operative times and lower complication rate while maintaining similar clinical outcomes as straight laparoscopic techniques for patients undergoing TPC IPAA.
Program Number: P187