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2006 Abstracts: Single Institution Comparison of Open, Hand-assist Laparoscopic, and Laparoscopic Colon and Rectal Surgical Technique
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Single Institution Comparison of Open, Hand-assist Laparoscopic, and Laparoscopic Colon and Rectal Surgical Technique
Ariel Forstner-Barthell1, Andrea Ferrara1, Joseph Gallagher1, Samuel DeJesus1, Paul Williamson1, Sergio Larach2, Paul Charron1, Eduardo Krajewski1; 1crc of orlando, orlando, FL; 2Colon and Rectal Surgery, Florida Hospital, Orlando, FL

Introduction: Few centers have the extensive experience with open, hand-assist laparoscopic and laparoscopic surgical approaches to colon and rectal surgery. A retrospective review was undertaken at a single center with a colon and rectal fellowship program comparing operative time, morbidity and mortality, and time to discharge for hand-assist, laparoscopic, and open approaches to abdominal colectomy. Methods: Retrospective review of database of all consecutive hand-assisted laparoscopic (hal) cases performed between May 2002 and September 2005 for benign and malignant disease by single surgeon. All converted cases were excluded. 68 cases were case-matched to laparoscopic and to open cases, using a database spanning 1990 to 2005. Cases were stratified according to the following procedures: APR, LAR, Left/Sigmoid, Right, Total. Cases were matched according to gender, co-morbidities, and stage (if malignant disease). Results: Co-morbidities were similar in all three groups, as was average BMI (28.5 k/m2). The overwhelming majority of hand-assist cases were done for malignant disease or unresectable polyp (96%), and >85% were done for stage 0-II disease. Length of surgery for all procedures trended longer from lap to hal to open (177, 195, 204 mins). Hal technique did not decrease surgical length for either sigmoid/left colectomies or for LAR, compared to lap technique, but it did shorten the time compared to open technique. Time to hospital discharge was significantly longer for the open group (8d) as opposed to the lap group (5d) or the hal group (6d). Significantly, the hal group for LAR left the hospital 1 day earlier than the lap group for LAR. Ninety-day post-op mortality in the hal group was zero, however two deaths occurred in the lap group - both from cardiac events. Morbidity from 30-90d was similar for all groups (7%). However, the hal group had a significantly greater immediate post-op complication rate (30% v 15%), primarily related to the incidence of wound infection (13%). Conclusions: Length of surgery was similar for all techniques, however, the hand-assist technique did not shorten operative time as compared to the laparoscopic technique. Hand-assist technique did result in shorter operative times than the open approach to abdominal colon and rectal surgery, and resulted in post-operative hospital stays as short or shorter than the laparoscopic technique. While the post-operative morbidity and mortality overall was low, there was a significantly high number of wound infections within the hand-assist group. However, this technique remains an important part of a surgeon’s armamentarium.


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