Hand-Assisted Laparoscopic Right Colectomy: How Does It Compare to Conventional Laparoscopy?

BACKGROUND: There is sufficient evidence to support the use of hand-assisted laparoscopy for sigmoid, total, and proctocolectomy. As a result, the hand-assisted technique has gained acceptance for these relatively complex types of colorectal surgery. For right colectomy, the use of conventional laparoscopy is supported by studies that have demonstrated its advantages over open surgery. Although the hand-assisted technique is also being used by some surgeons for right colectomy, there are few reported data to justify its use. With this deficiency in mind, we performed a study to compare the short-term outcomes of right colectomy performed by either the hand-assisted or conventional laparoscopic technique. STUDY DESIGN: A single-center retrospective analysis was performed. Patients who underwent hand-assisted or conventional laparoscopic right colectomy were identified from a prospectively maintained departmental database. Preoperative clinical information, details of the operation, lymph node count for cancer cases, postoperative morbidity, length of stay, and 30-day hospital readmissions were evaluated. RESULTS: From 2006 to 2009, 43 hand-assisted and 84 conventional laparoscopic right colectomies were performed. Comparison of the hand-assisted and conventional laparoscopic groups revealed no differences in the preoperative clinical variables, including average body mass index (calculated as kg/m(2); 28 and 29), percent obese (33% and 34%), earlier abdominal surgery (30% and 39%), operative time (122 and 126 minutes), lymph nodes evaluated for cancer cases (22 and 21), postoperative morbidity (30%), length of stay (5 days), or 30-day hospital readmission (16% and 11%). CONCLUSIONS: Short-term outcomes of hand-assisted and conventional laparoscopic right colectomy are similar. The decision to perform hand-assisted or conventional laparoscopic right colectomy should be based on the surgeons' preference and not on the perception that one technique is preferable to the other. (J Am Coll Surg 2011;212:367-372. (c) 2011 by the American College of Surgeons)