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Objective:
Pure laparoscopic-assisted colectomy (LC) is technically complex and hand-assisted laparoscopic surgery (HALS) continues to be a popular alternative. Despite significant experience, national data continues to show strong popularity for HALS and minimal transition towards LC with surgeon preference commonly being exclusive to one technique. This study aims to document the surgical trends of HALS and LC within a mature high volume colorectal practice and to identify which patients and disease characteristics lend themselves to HALS.
Design:
Retrospective study.
Setting:
Tertiary care center.
Patients:
Those undergoing elective HALS, LAC, and open surgery for colon cancer, inflammatory bowel disease (IBD), or diverticular disease.
Interventions:
N/A
Main Outcome Measures:
N/A
Results:
In comparing all colectomies, we have observed an increase in LC (2006, 39.4%; 2010, 68.6%, p<0.0001) with a decline in HALS (2006, 40.2%; 2010, 15.9%, p<0.0001). The number of open cases has remained constant (2006, 20.3%; 2010, 15.5%, p=0.2629). Factors specific to HALS and open cases include presence of fistulae, abscess, dense adhesions, and large tumor size. Greatest benefit for HALS was seen in the colon cancer subgroup where HALS was associated with decreased EBL (p=0.0003) and shorter hospital stay (p=0.0049) as compared to open surgery. Current utilization of HALS demonstrates significant subgroup variation (diverticulitis 33.3%; colon cancer 10.7%; IBD 4.1%).
Conclusions:
Our practice has undergone a strong transition towards LC with a concurrent decline in HALS, and our experience supports HALS acting as a technical bridge towards LC. Moreover, our experience illustrates that LC and HALS are not mutually exclusive techniques. Rather, HALS continues to play an important role in mature laparoscopically-advanced colorectal practices, as it provides benefit in complex cases with specific characteristics.