Advantages of the hand-assisted versus the open approach to elective colectomies

Background: Hand-assisted laparoscopic colectomy has been introduced as an alternative to standard laparoscopy. However, to date, it has not been established whether intraabdominal placement of a hand abrogates the benefits of minimally invasive techniques. The authors hypothesized that the hand-assisted approach confers advantages of minimal access surgery over traditional open colectomy. Methods: Consecutive patients undergoing elective open (OC) and hand-assisted (HALC) colon resections were retrospectively reviewed. Open colectomies performed by the laparoscopic surgeons were excluded. Outcome measures included patient demographics, operative time, perioperative complications, operative and total hospital charges, and length of hospital stay. Statistical analysis was performed with a p value less than 0.05 considered significant. Results: The study identified and reviewed 323 consecutive elective OCs and 66 consecutive elective HALCs. Of these, 228 OCs (70.6%) and 52 HALCs (78.8%) were left-sided. The two groups were similar in age, sex, and body mass index (BMI). The mean operative time was longer in the HALC group (202 vs 160 min; p < 0.05). No major intraoperative complications occurred in either group, and no conversions from HALC to OC were performed. Postoperatively, 14 OC patients (3.8%) required blood transfusion versus no HALC patients. The rate of wound infections also was higher in the OC group (3.4%, n = 11) than in the HALC group (1.5%, n = 1) (p = 0.04). All seven mortalities (2.3%) occurred in the OC group. The median hospital stay was significantly shorter in the HALC group (5.3 vs 8.4 days; p < 0.001). The total hospital charges were significantly lower in the HALC group ($24,132 vs $33,150; p < 0.001). Conclusion: Hand-assisted laparoscopic colectomy is a safe alternative to traditional open colonic resection. In this series, it was associated with decreased postoperative morbidity and mortality. Despite longer operative times, the use of the hand-assisted techniques significantly reduced the hospital stay and decreased the total hospital charges. Overall, in the elective setting, hand-assisted laparoscopic colectomy appears to be advantageous over the traditional open colectomy.