B. F. Gilmore1, Z. Sun1, M. Adam1, J. Kim1, B. Ezekian1, C. Ong1, J. Migaly1, C. Mantyh1 1Duke University,Department Of Surgery,Durham, NC, USA
Introduction:
Hand-assisted laparoscopic (HAL) colectomy is a technique perceived to combine the benefits of laparoscopic surgery, while improving tactile feedback and operative time. Published data are largely limited to small, single institution studies. Our aim was to compare post-operative outcomes between HAL vs. standard laparoscopic (SL) approaches on a population level.
Methods:
The 2012-2013 National Surgical Quality Improvement Program Participant Data Use File was queried for patients undergoing elective SL or HAL colectomy. Patients were classified by surgical approach, underwent 1:1 propensity matching with a nearest neighbor algorithm, and had outcomes compared. An additional subgroup analysis was performed for patients undergoing segmental resections only.
Results:
A total of 13,949 patients were identified, of whom 6,084 (43.6%) underwent HAL colectomy. Following propensity matching, patients undergoing HAL vs. SL colectomy had higher rates of post-operative ileus (8.7% vs. 6.3%, p<0.001), wound complications (8.8% vs. 6.8%, p=0.006), and 30-day readmission (7.5% vs. 6.0%, p=0.002), without any differences in operative time (156 vs. 157 minutes, p=0.713). When considering only segmental colectomies, HAL remained associated with significantly higher rates of wound complications (8.6% vs. 6.5%, p=0.016), post-operative ileus (8.9% vs. 6.3%, p<0.001), and 30-day readmission (7.1% vs. 5.9%, p=0.041). There was again no difference in operative time between HAL and SL (145 vs. 145 minutes, p=0.334).
Conclusion:
Use of hand-assisted laparoscopic colectomy is associated with increased risk of wound complications, post-operative ileus, and readmissions. Importantly, this technique is not associated with any decrease in operative time. Our results suggest that utilization of hand-assisted technique should be discouraged, given its inferior outcomes. However, further investigations are warranted to determine situations where hand-assisted approach may be more appropriate, such as cases with increased technical difficulty.