Hassan Imran, You Y Nancy, Cima Robert R, Larson David W, Dozois Eric J, Barnes S A, Pemberton John H
Division of General Surgery, SIU School of Medicine, Springfield, II 62794, USA.
Surg Endosc. 2008 Mar;22(3):739-43. doi: 10.1007/s00464-007-9477-4.
Laparoscopic assisted (LA) colectomy has significant patient benefits but is technically challenging. Hand-assisted laparoscopic surgery (HALS) allows tactile feedback because the surgeon's hand assists in retraction and dissection. This may decrease the technical difficulty and shorten the learning curve associated with performing laparoscopic colectomy. We investigated the patient selection and short-term clinical outcomes of HALS and LA since the introduction of HALS to our minimally invasive colorectal practice.
Prospectively collected data on 258 patients undergoing HALS (n = 109) or LA colectomy (n = 149) during a calendar year (2004) were analyzed. Patient and disease characteristics, operative parameters, and perioperative outcomes were compared.
HALS patients were similar to LA patients in age (51 vs. 54 yrs), gender (56 vs. 52% male), body mass index (26 vs. 26 kg/m2), comorbidities (84 vs. 85% with one or more), and diagnosis (83 vs. 80% benign), but differed in incidence of previous surgery (49 vs. 30%; P = 0.008). A significantly greater proportion of HALS patients underwent complex procedures and extensive resections. Conversion rates (15 vs. 11%, P = 0.44), intraoperative complications (4 vs. 1%, P = 0.17), 30-day morbidity (18 vs. 11%, P = 0.12) and surgical reinterventions (2 vs. 1%, P = 0.58) did not differ. Recovery measured by days to flatus was not different [mean (standard deviation) 3(2) vs. 3(2) days, P = 0.26], however HALS patients had longer operative times [276(96) vs. 211(107) minutes P < 0.0001] and 1 day longer stay in hospital [6(3) vs. 5 (3) days, P = 0.0009)].
Patients undergoing HALS underwent more-complex procedures than LA patients but retained the short-term benefits associated with LA colectomy. HALS facilitates expansion of a minimally invasive colectomy practice to include more challenging procedures while maintaining short-term patient benefits.
腹腔镜辅助结肠切除术对患者有显著益处，但技术上具有挑战性。手辅助腹腔镜手术（HALS）可提供触觉反馈，因为外科医生的手有助于牵拉和解剖。这可能会降低技术难度，并缩短与实施腹腔镜结肠切除术相关的学习曲线。自HALS引入我们的微创结直肠手术实践以来，我们对HALS和腹腔镜辅助（LA）结肠切除术的患者选择及短期临床结果进行了研究。
分析了在一个日历年（2004年）前瞻性收集的258例行HALS（n = 109）或LA结肠切除术（n = 149）患者的数据。比较了患者和疾病特征、手术参数及围手术期结果。
HALS组患者与LA组患者在年龄（51岁对54岁）、性别（男性分别为56%对52%）、体重指数（26对26kg/m²）、合并症（有一项或多项合并症的分别为84%对85%）及诊断（良性疾病分别为83%对80%）方面相似，但既往手术发生率不同（49%对30%；P = 0.008）。HALS组患者接受复杂手术和广泛切除的比例显著更高。中转率（15%对11%，P = 0.44）、术中并发症（4%对1%，P = 0.17）、30天发病率（18%对11%，P = 0.12）及再次手术干预（2%对1%，P = 0.58）无差异。以排气天数衡量的恢复情况无差异[平均（标准差）3（2）天对3（2）天，P = 0.26]，然而HALS组患者手术时间更长[276（96）分钟对211（107）分钟，P < 0.0001]，住院时间长1天[6（3）天对5（3）天，P = 0.0009]。
与LA组患者相比，接受HALS的患者手术更为复杂，但保留了与LA结肠切除术相关的短期益处。HALS有助于将微创结肠切除术实践扩展至包括更具挑战性的手术，同时维持患者的短期获益。
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