Hand-assisted laparoscopy leads to efficient colorectal cancer surgery

Sonia T. Orcutt, Christy L. Marshall, Courtney J. Balentine, Celia N. Robinson, Daniel A. Anaya, Avo Artinyan, David H. Berger, Daniel Albo

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Laparoscopic-assisted (LA) colorectal resections have improved short-term outcomes compared with open resections. Lack of tactile feedback, though, has led to lengthy operations and high conversion rates with attendant adverse effects on patients. Hand-assisted laparoscopy (HAL), in contrast, provides tactile feedback while still being minimally invasive. We hypothesize that HAL compared with LA for colorectal cancer resections will be associated with lower conversion rates and decreased operative times, without compromising the advantages of laparoscopy. Materials and methods: We performed a retrospective case-matched study of patients undergoing LA or HAL colorectal cancer resections from 2002 to 2010, using a prospectively maintained colorectal cancer database at a Veterans Affairs Medical Center. Short-term outcomes analyzed (using the Wilcoxon signed rank and McNemar's tests) included operative and perioperative variables and surrogate markers of adequacy of oncologic care. Results: Forty-seven LA patients were matched 1:1 by age and resection with 47 HAL patients. Patients in the HAL group had significantly lower blood loss (100 versus 150 cc, P = 0.04), operative times (206 versus 252 min, P = 0.002), and conversion rates (6% versus 38%, P < 0.0005). They also spent fewer days in the intensive care unit (0 versus 1, P = 0.004) and had quicker return of flatus (3 versus 4 d, P = 0.03). HAL resulted in more lymph nodes resected (21 versus 15, P = 0.03) and a more adequate lymph node harvest (98% versus 77%, P = 0.01). Conclusions: HAL is associated with improved operative efficiency, conversion rates, and lymphadenectomy as compared with LA colorectal cancer resections. HAL should be considered in the management of colorectal cancer patients.

Original languageEnglish (US)
JournalJournal of Surgical Research
Volume177
Issue number2
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

Fingerprint

Hand-Assisted Laparoscopy
Colorectal Surgery
Colorectal Neoplasms
Touch
Operative Time
Lymph Nodes
Flatulence
Veterans
Lymph Node Excision
Laparoscopy
Intensive Care Units
Biomarkers
Databases

Keywords

  • Colorectal cancer
  • Hand-assisted laparoscopy
  • Operative efficiency
  • Short-term outcomes

ASJC Scopus subject areas

  • Surgery

Cite this

Orcutt, S. T., Marshall, C. L., Balentine, C. J., Robinson, C. N., Anaya, D. A., Artinyan, A., ... Albo, D. (2012). Hand-assisted laparoscopy leads to efficient colorectal cancer surgery. Journal of Surgical Research, 177(2). https://doi.org/10.1016/j.jss.2012.02.051

Hand-assisted laparoscopy leads to efficient colorectal cancer surgery. / Orcutt, Sonia T.; Marshall, Christy L.; Balentine, Courtney J.; Robinson, Celia N.; Anaya, Daniel A.; Artinyan, Avo; Berger, David H.; Albo, Daniel.

In: Journal of Surgical Research, Vol. 177, No. 2, 01.10.2012.

Research output: Contribution to journalArticle

Orcutt, ST, Marshall, CL, Balentine, CJ, Robinson, CN, Anaya, DA, Artinyan, A, Berger, DH & Albo, D 2012, 'Hand-assisted laparoscopy leads to efficient colorectal cancer surgery', Journal of Surgical Research, vol. 177, no. 2. https://doi.org/10.1016/j.jss.2012.02.051
Orcutt ST, Marshall CL, Balentine CJ, Robinson CN, Anaya DA, Artinyan A et al. Hand-assisted laparoscopy leads to efficient colorectal cancer surgery. Journal of Surgical Research. 2012 Oct 1;177(2). https://doi.org/10.1016/j.jss.2012.02.051
Orcutt, Sonia T. ; Marshall, Christy L. ; Balentine, Courtney J. ; Robinson, Celia N. ; Anaya, Daniel A. ; Artinyan, Avo ; Berger, David H. ; Albo, Daniel. / Hand-assisted laparoscopy leads to efficient colorectal cancer surgery. In: Journal of Surgical Research. 2012 ; Vol. 177, No. 2.
@article{43de79e7deba425cb6b1cc365378be7d,
title = "Hand-assisted laparoscopy leads to efficient colorectal cancer surgery",
abstract = "Background: Laparoscopic-assisted (LA) colorectal resections have improved short-term outcomes compared with open resections. Lack of tactile feedback, though, has led to lengthy operations and high conversion rates with attendant adverse effects on patients. Hand-assisted laparoscopy (HAL), in contrast, provides tactile feedback while still being minimally invasive. We hypothesize that HAL compared with LA for colorectal cancer resections will be associated with lower conversion rates and decreased operative times, without compromising the advantages of laparoscopy. Materials and methods: We performed a retrospective case-matched study of patients undergoing LA or HAL colorectal cancer resections from 2002 to 2010, using a prospectively maintained colorectal cancer database at a Veterans Affairs Medical Center. Short-term outcomes analyzed (using the Wilcoxon signed rank and McNemar's tests) included operative and perioperative variables and surrogate markers of adequacy of oncologic care. Results: Forty-seven LA patients were matched 1:1 by age and resection with 47 HAL patients. Patients in the HAL group had significantly lower blood loss (100 versus 150 cc, P = 0.04), operative times (206 versus 252 min, P = 0.002), and conversion rates (6{\%} versus 38{\%}, P < 0.0005). They also spent fewer days in the intensive care unit (0 versus 1, P = 0.004) and had quicker return of flatus (3 versus 4 d, P = 0.03). HAL resulted in more lymph nodes resected (21 versus 15, P = 0.03) and a more adequate lymph node harvest (98{\%} versus 77{\%}, P = 0.01). Conclusions: HAL is associated with improved operative efficiency, conversion rates, and lymphadenectomy as compared with LA colorectal cancer resections. HAL should be considered in the management of colorectal cancer patients.",
keywords = "Colorectal cancer, Hand-assisted laparoscopy, Operative efficiency, Short-term outcomes",
author = "Orcutt, {Sonia T.} and Marshall, {Christy L.} and Balentine, {Courtney J.} and Robinson, {Celia N.} and Anaya, {Daniel A.} and Avo Artinyan and Berger, {David H.} and Daniel Albo",
year = "2012",
month = "10",
day = "1",
doi = "10.1016/j.jss.2012.02.051",
language = "English (US)",
volume = "177",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "2",

}

TY - JOUR

T1 - Hand-assisted laparoscopy leads to efficient colorectal cancer surgery

AU - Orcutt, Sonia T.

AU - Marshall, Christy L.

AU - Balentine, Courtney J.

AU - Robinson, Celia N.

AU - Anaya, Daniel A.

AU - Artinyan, Avo

AU - Berger, David H.

AU - Albo, Daniel

PY - 2012/10/1

Y1 - 2012/10/1

N2 - Background: Laparoscopic-assisted (LA) colorectal resections have improved short-term outcomes compared with open resections. Lack of tactile feedback, though, has led to lengthy operations and high conversion rates with attendant adverse effects on patients. Hand-assisted laparoscopy (HAL), in contrast, provides tactile feedback while still being minimally invasive. We hypothesize that HAL compared with LA for colorectal cancer resections will be associated with lower conversion rates and decreased operative times, without compromising the advantages of laparoscopy. Materials and methods: We performed a retrospective case-matched study of patients undergoing LA or HAL colorectal cancer resections from 2002 to 2010, using a prospectively maintained colorectal cancer database at a Veterans Affairs Medical Center. Short-term outcomes analyzed (using the Wilcoxon signed rank and McNemar's tests) included operative and perioperative variables and surrogate markers of adequacy of oncologic care. Results: Forty-seven LA patients were matched 1:1 by age and resection with 47 HAL patients. Patients in the HAL group had significantly lower blood loss (100 versus 150 cc, P = 0.04), operative times (206 versus 252 min, P = 0.002), and conversion rates (6% versus 38%, P < 0.0005). They also spent fewer days in the intensive care unit (0 versus 1, P = 0.004) and had quicker return of flatus (3 versus 4 d, P = 0.03). HAL resulted in more lymph nodes resected (21 versus 15, P = 0.03) and a more adequate lymph node harvest (98% versus 77%, P = 0.01). Conclusions: HAL is associated with improved operative efficiency, conversion rates, and lymphadenectomy as compared with LA colorectal cancer resections. HAL should be considered in the management of colorectal cancer patients.

AB - Background: Laparoscopic-assisted (LA) colorectal resections have improved short-term outcomes compared with open resections. Lack of tactile feedback, though, has led to lengthy operations and high conversion rates with attendant adverse effects on patients. Hand-assisted laparoscopy (HAL), in contrast, provides tactile feedback while still being minimally invasive. We hypothesize that HAL compared with LA for colorectal cancer resections will be associated with lower conversion rates and decreased operative times, without compromising the advantages of laparoscopy. Materials and methods: We performed a retrospective case-matched study of patients undergoing LA or HAL colorectal cancer resections from 2002 to 2010, using a prospectively maintained colorectal cancer database at a Veterans Affairs Medical Center. Short-term outcomes analyzed (using the Wilcoxon signed rank and McNemar's tests) included operative and perioperative variables and surrogate markers of adequacy of oncologic care. Results: Forty-seven LA patients were matched 1:1 by age and resection with 47 HAL patients. Patients in the HAL group had significantly lower blood loss (100 versus 150 cc, P = 0.04), operative times (206 versus 252 min, P = 0.002), and conversion rates (6% versus 38%, P < 0.0005). They also spent fewer days in the intensive care unit (0 versus 1, P = 0.004) and had quicker return of flatus (3 versus 4 d, P = 0.03). HAL resulted in more lymph nodes resected (21 versus 15, P = 0.03) and a more adequate lymph node harvest (98% versus 77%, P = 0.01). Conclusions: HAL is associated with improved operative efficiency, conversion rates, and lymphadenectomy as compared with LA colorectal cancer resections. HAL should be considered in the management of colorectal cancer patients.

KW - Colorectal cancer

KW - Hand-assisted laparoscopy

KW - Operative efficiency

KW - Short-term outcomes

UR - http://www.scopus.com/inward/record.url?scp=84866047019&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866047019&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2012.02.051

DO - 10.1016/j.jss.2012.02.051

M3 - Article

C2 - 22841382

AN - SCOPUS:84866047019

VL - 177

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 2

ER -