Utility and Short-term Outcomes of Hand-assisted Laparoscopic Colorectal Surgery: A Single-Institution Experience in 1103 Patients

BACKGROUND: Despite its introduction in 1991, laparoscopic colectomy is performed in < 10% of United States patients requiring colectomy. Laparoscopic colectomy is avoided principally because of its technical difficulty, steep learning curve, and increased operative times. Hand-assisted laparoscopic colectomy is an alternative technique that addresses these problems while preserving the short-term benefits of laparoscopic colectomy. OBJECTIVE: To describe the utility and short-term outcomes, we evaluated 1103 patients who underwent hand-assisted laparoscopic colorectal resections over a 5-year period. DESIGN: This study was a retrospective analysis of prospectively collected data. SETTINGS: The setting was a single tertiary care institution. PATIENTS: A total of 1103 consecutive hand-assisted laparoscopic colorectal resections from 2004 to 2009 were identified using a prospectively maintained database. MAIN OUTCOME MEASURES: Demographics, perioperative variables, and 30-day outcomes were reported. Data are presented as frequency (proportion) or median (interquartile range). RESULTS: A total of 1103 hand-assisted laparoscopic colorectal resections were documented. Median age of patients was 55 years; 47% were women, and median body mass index was 26.5 (range, 23-34) kg/m(2). Diagnoses included inflammatory bowel disease (35%), colorectal cancer (31%), diverticular disease (23%), and "other" (11%). Forty-two percent of patients had prior abdominal surgery. Segmental colectomies were performed in 533 (48%) patients, proctocolectomy with ileal pouch-anal anastomosis in 229 (21%), proctocolectomy with end ileostomy in 114 (10%), and "other" in 227 (21%). The conversion rate was 9%. Overall median operative time was 201 (range, 145-269) minutes, and the median postoperative length of stay was 5 (range, 4-7) days. Postoperative complications occurred in 27% and readmissions in 7%; mortality was 0.3%. LIMITATIONS: This was a single institutional retrospective study. CONCLUSIONS: Hand-assisted laparoscopic colorectal resection can be performed for numerous indications. It preserves nearly all the benefits of laparoscopic colectomy reported in the literature. With experience, it is associated with significantly reduced operative times. Wider adoption of hand-assisted laparoscopic colorectal surgery would increase the number of patients benefiting from minimal access colorectal surgery.