Vaccaro Carlos, Gonzalez Marcos, Ruffa Tatiana, Campana Juan Pablo, Mentz Ricardo, Poggi Catalina, Rubinstein Fernando, Marcello Peter
Hospital italiano de buenos aires.
Instituto de efectividad clinica y sanitaria.
Rev Fac Cien Med Univ Nac Cordoba. 2022 Jun 6;79(2):150-155. doi: 10.31053/1853.0605.v79.n2.35412.
Hand-assisted laparoscopic colorectal surgery (HALS) is an alternative to straight laparoscopic approach (SL) that requires the use of a specific device to maintain the pneumoperitoneum. Our group has described an original double glove technique to replace it. Our purpose was to compare perioperative outcomes of patients undergoing HALS using this original technique vs SL.
Retrospective review of a prospective database including patients who underwent elective laparoscopic colorectal resections between 2004 to 2020 at the Hospital Italiano, Argentina. Logistic regression analysis, propensity score matching, and inverse probability weighting were used to estimate adjusted treatment effects for perioperative outcomes.
HALS (n=458) and SL (n=1692) cases were demographically similar. HALS was associated with a shorter operative time (170.3 vs 206.9 minutes, p<0.001). Such difference was even more pronounced in obese (44.1 min), large patients (37.5 min), complex procedures (33.8 min) and surgeries carried out by non-trained surgeons (57,6 vs 31,6 minutes, p<0.001). Hand-assisted was associated with a lower conversion rate (5% vs 9.9%, p<0.001) with an adjusted odds ratio of 0.45 (95%CI 0.28-0.73). No difference in hospital stay, morbidity, and readmission rates was found.
HALS with double-glove technique is comparable to SL in terms of postoperative outcomes keeping reduced operative time and conversion rates, especially in obese patients undergoing complex procedures.
手辅助腹腔镜结直肠手术（HALS）是传统腹腔镜手术（SL）的一种替代方法，后者需要使用特定设备来维持气腹状态。我们团队描述了一种原创的双层手套技术来替代该设备。我们的目的是比较采用这种原创技术的HALS患者与SL患者的围手术期结局。
对一个前瞻性数据库进行回顾性分析，该数据库纳入了2004年至2020年在阿根廷意大利医院接受择期腹腔镜结直肠切除术的患者。采用逻辑回归分析、倾向评分匹配和逆概率加权来估计围手术期结局的调整治疗效果。
HALS组（n = 458）和SL组（n = 1692）在人口统计学特征上相似。HALS与较短的手术时间相关（170.3分钟对206.9分钟，p < 0.001）。这种差异在肥胖患者（44.1分钟）、体型较大的患者（37.5分钟）、复杂手术（33.8分钟）以及由非训练有素的外科医生进行的手术中更为明显（57.6分钟对31.6分钟，p < 0.001）。手辅助与较低的中转率相关（5%对9.9%，p < 0.001），调整后的优势比为0.45（95%CI 0.28 - 0.73）。在住院时间、发病率和再入院率方面未发现差异。
采用双层手套技术的HALS在术后结局方面与SL相当，同时手术时间和中转率降低，尤其是在接受复杂手术的肥胖患者中。
