Hand-assisted laparoscopic versus open right hemicolectomy: short-term outcomes in a single institution from China.
ABSTRACT To compare the perioperative parameters and short-term outcomes of hand-assisted laparoscopic colectomy (HALC) and open colectomy (OC) for the treatment of patients with cancer of the right hemicolon.
Patients who were scheduled to perform right hemicolectomy between August 2009 and December 2010 were randomized into either HALC or OC group. Patients were excluded if they had synchronous cancers, hepatic metastases, acute intestinal obstruction, or intestinal perforations. All the operations in the 2 groups were performed by a single surgical team. Measured outcomes included the demographic variables and perioperative parameters. The former included age, sex, body mass index, American Society of Anesthesiologists class, prior abdominal surgery, distribution of tumors, and histopathologic stage; whereas the latter included length of incision, operative time, estimated blood loss, conversion rate, number of lymph nodes retrieved, postoperative pain score, time to return of bowel function, postoperative complications, duration of hospital stay, and total cost.
One hundred sixteen patients with cancer of the right hemicolon (HALC=59, OC=57) were recruited. The 2 groups of patients were similar in age, sex distribution, body mass index, American Society of Anesthesiologists class, and previous abdominal surgery. No significant difference was observed between the 2 groups in terms of distribution of tumors and the final histopathologic staging. HALC had a significantly shorter incision length and longer operative time than OC. Patients in the HALC group had significantly less operative blood loss, less pain and earlier passage of flatus after operation than those in the OC group. The number of lymph nodes recovered in the specimen and the overall postoperative complications was comparable in the 2 groups. The postoperative duration of hospital stay was significantly shorter in the HALC group, whereas the median overall costs in the HALC group were significantly higher than that in the OC group.
The results from the present study demonstrate that the HALC is a valid surgical approach for cancer of the right hemicolon that retains the benefits of minimally invasive surgery. We believe that this technique is a safe, useful, and feasible method for patients with right-sided colonic cancer. If practiced more, it might be advocated as a "bridge" between traditional laparoscopic surgery and conventional open procedures.
- SourceAvailable from: wjgnet.com[show abstract] [hide abstract]
ABSTRACT: To design a hand-assisted laparoscopic approach in an attempt to provide an option for laparoscopic resection of abdominal large viscera. A 5-6 cm incision (for HandPort) and 2 trocars were employed. The main vessel of the target organ was taken as a "core", and all tissues around the core were taken as peripheral structures. The peripheral structures were dissected first, and the core vessels were treated last. Twenty-six patients underwent laparoscopic deroofing of the hepatic huge cysts, resection of the segments lying at the outer edge of the liver (segments 2 to 6), splenectomy, hemicolectomy, ileocecectomy and subtotal gastrectomy with HandPort device, harmonic scalpel, or Ligasure. The duration of the procedure was within 2 h. Blood loss amounted to 8-120 mL. The conversion rate was 3.8% (1/26). All patients had uneventful postoperative courses with less pain, earlier oral intake, and faster recovery, compared with conventional surgery. This method combines the advantages of both open and laparoscopic techniques, achieving better hemostasis effect, shortening the operative time, and is beneficial to the patients.World Journal of Gastroenterology 09/2006; 12(29):4736-40. · 2.55 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: The first case of a villous lesion of the colon removed by laparoscopic-guided surgery is reported. Injection of methylene blue into the lesion facilitated its access and exposure via the laparoscope. A very small skin incision allowed delivery onto the abdominal wall for resection and anastomoses.Journal of laparoendoscopic surgery 09/1991; 1(4):221-4.
- [show abstract] [hide abstract]
ABSTRACT: To review the initial experience and compare the results of hand-assisted laparoscopic distal gastrectomy (HALDG), totally laparoscopic distal gastrectomy (TLDG), and open distal gastrectomy (ODG) in the treatment of gastric cancer in a regional hospital. Consecutive patients who received distal gastrectomy for stage 1 or 2 gastric cancer were reviewed retrospectively. Lymphatic dissection and intracorporeal anastomosis were initially performed using the HALDG approach, and subsequently the TLDG approach. The results were compared with those of the ODG approach, and the overall survival was compared between the laparoscopic and open surgery groups. Sixty-nine patients underwent distal gastrectomies and 28 gastrectomies were performed using the laparoscopic approach (HALDG=10; TLDG=18). Patients who underwent HALDG required less operative time (median, 212 min vs. 263 min; P=0.04), whereas patients who underwent TLDG had reduced complication rates and a shorter hospital stay (median, 16 d vs. 8 d, respectively; P=0.009). When compared with ODG, the laparoscopic approach required a longer operative time but incurred significantly less blood loss (median, 75 mL vs. 175 mL, respectively; P=0.004). There was no difference in overall operative morbidity, hospital stay, oncologic clearance, or overall survival between the laparoscopic and open approaches. TLDG is technical demanding and requires longer operation time. The use of the hand-assisted approach for beginner surgeons may serve as a bridge to acquire skill for TLDG.Surgical laparoscopy, endoscopy & percutaneous techniques 09/2009; 19(4):298-304. · 0.88 Impact Factor