Comparison of conventional laparoscopic and hand-assisted oncologic segmental colonic resection

Laparoscopically assisted colon resection has evolved to be a viable option for the treatment of colorectal cancer. This study evaluates the efficacy of hand-assisted laparoscopic surgery (HALS) as compared with totally laparoscopic surgery (LAP) for segmental oncologic colon resection with regard t...

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Bibliographic Details
Published in:	Surgical endoscopy Vol. 21; no. 12; pp. 2137 - 2141
Main Authors:	RINGLEY, C, LEE, Y. K, IQBAL, A, BOCHAREV, V, SASSON, A, MCBRIDE, C. L, THOMPSON, J. S, VITAMVAS, M. L, OLEYNIKOV, D
Format:	Journal Article
Language:	English
Published:	New York, NY Springer 01-12-2007 Springer Nature B.V
Subjects:	Aged Aged, 80 and over Biological and medical sciences Blood Loss, Surgical Colectomy - methods Colectomy - standards Colonic Neoplasms - surgery Colorectal Neoplasms - surgery Digestive system. Abdomen Endoscopy Female Gastroenterology. Liver. Pancreas. Abdomen General aspects Humans Investigative techniques, diagnostic techniques (general aspects) Laparoscopy - standards Length of Stay Lymph Node Excision - methods Lymph Nodes - pathology Male Medical sciences Middle Aged Neoplasm Staging Retrospective Studies Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Time Factors Tumors Human Rectal disease Lymph node Colorectal cancer Bowel Clinical papers/trials/research Colectomy Laparoscopy Malignant tumor Hand Colonic disease Medicine Treatment Surgery Technical Digestive diseases Intestinal disease Clinical trial Surgical technical Endoscopy Colon Comparative study Cancer
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Summary:	Laparoscopically assisted colon resection has evolved to be a viable option for the treatment of colorectal cancer. This study evaluates the efficacy of hand-assisted laparoscopic surgery (HALS) as compared with totally laparoscopic surgery (LAP) for segmental oncologic colon resection with regard to lymph node harvest, operative times, intraoperative blood loss, pedicle length, incision length, and length of hospital stay in an attempt to help delineate the role of each in the treatment of colorectal cancer. Patient charts were retrospectively reviewed to acquire data for this evaluation. Between June 2001 and July 2005, 40 patients underwent elective oncologic segmental colon resection (22 HALS and 18 LAP). The main outcome measures included lymph node harvest, operative times, intraoperative blood loss, pedicle length, incision length, and length of hospital stay. The two groups were comparable in terms of demographics. The tumor margins were clear in all the patients. The HALS resection resulted in a significantly higher lymph node yield than the LAP resection (HALS: 16 nodes; range, 5-35 nodes vs LAP: 8 nodes; range, 5-22 nodes; p < 0.05) and significantly shorter operative times (HALS: 120 min; range, 78-181 min vs LAP: 156 min; range, 74-300 min; p < 0.05). Both groups were comparable with regard to length of hospital stay, pedicle length, and intraoperative blood loss. However, the LAP group yielded a significantly smaller incision for specimen extraction (LAP: 7 cm; range, 6-8 cm vs HALS: 5.5 cm; range, 5-7 cm; p < 0.05). The findings suggest that hand-assisted laparoscopic oncologic segmental colonic resection is associated with shorter operative times, more lymph nodes harvested, and equivalent hospital stays, pedicle lengths, and intraoperative blood losses as compared with the totally laparoscopic approach. The totally laparoscopic technique was completed with a smaller incision. However, this less than 1 cm reduction in incision length has doubtful clinical significance.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0930-2794 1432-2218
DOI:	10.1007/s00464-007-9401-y