Surgery News - December 2007 - (Page 13)

DECEMBER 2007 • SURGERY NEWS GENERAL SURGERY 13 Hand-Assisted Method Eases Laparoscopic Colectomy B Y K AT E J O H N S O N Else vier Global Medical Ne ws M O N T R E A L — The difficulties encountered during laparoscopic colectomy do not always necessitate conversion to an open procedure if surgeons can master a hand-assisted laparoscopic approach, according to Dr. Wen-Yao Yin, who presented results of his research at a meeting sponsored by the International Society of Surgery. “Even experienced surgeons in large, specialized centers are doing laparoscopic colectomy in difficult cases, with a conversion to open in about 12%-20%. If you use a hand-assisted laparoscopic technique, you can reduce very significantly the conversion to open,” Dr. Yin, an ACS Fellow, said in an interview. “With laparoscopy you still need a 6-cm incision to remove the specimen, so why not use this wound initially to insert a hand? One hand inside is worth more than a hundred trocars!” The purely laparoscopic approach to colectomy is not popular because it is technically challenging and associated with complications, said Dr. Yin, chief of surgery at the Buddhist Dalin Tzu Chi General Hospital in Taiwan. However, when performed successfully it can significantly reduce recovery time and length of hospital stay. Surgeons might be less intimidated by laparoscopy if they had the hand-assisted technique to fall back on, he said. His study compared 36 laparoscopic colectomies (mean patient age 64 years) to 30 open colectomies (mean patient age 63 years), and found a significantly shorter time to ambulation (4 days vs. 6 days) and length of hospital stay (9 days vs. 11 days) in the laparoscopic group. The laparoscopic results included eight procedures that were converted to the hand-assisted approach because of excessive bleeding in two cases, and because of obscure anatomy, large tumor size, technical failure, arrhythmia and hypercapnia, severe adhesions, and tumor invasion among the other cases. Complication rates were similar for both groups, although one-third of the open group patients had hospital stays exceeding 2 weeks, compared with only one-quarter of the laparoscopic group—a significant difference, he noted. Over a mean follow-up period of 2 years, the laparoscopic and open groups had similar recurrence rates (25% vs. 26.6%, respectively) and survival rates (86% vs. 77%, respectively). In an earlier study comparing 25 handassisted laparoscopic colectomies (mean patient age 62.5 years) with 19 open colectomies (mean patient age 63.5 years), Dr. Yin found a significantly shorter time to ambulation (4.8 days vs. 7.1 days) and length of hospital stay (8.5 days vs. 11.1 days) in the laparoscopic vs. open groups. Operating time is significantly shorter for open colectomy than for the laparoscopic approach, Dr. Yin acknowledged. In his most recent study, the mean operating times were 180 minutes and 260 minutes, respectively, for the open and laparoscopic approaches. This difference also was reflected in the earlier study, which showed a mean operating time of 302 minutes for hand-assisted laparoscopy, compared with 183 minutes for the open technique. However, the hand-assisted technique does have a learning curve, he emphasized. When he compared the most recent study’s first 10 procedures with the last 26, he noted a reduction in operating time from 352 to 271 minutes. ■ A hand-assisted approach preserves the benefit of conventional laparoscopic colectomy and can reduce the rate of conversion to an open procedure. American College of Surgeons 94th annual Clinical Congress October 12–16, 2008: San Francisco, CA Moscone Convention Center Save the Date! Join us in San Francisco for the 94th annual Clinical Congress. As always, it will be an educational opportunity you won’t want to miss! Please be sure to visit www.facs.org in the coming months for more details regarding the educational program, registration, housing, and transportation. COURTESY DR. WEN-YAO YIN http://www.facs.org

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Surgery News - December 2007 Contents Breast Radiation Boost Cuts Cancer Recurrence Mortality Soars in Some Patients With Respiratory Distress New Codes Promote Alcohol Screening New Ideas News From the College: Quality Standards General Surgery: Helping Hand Trauma: Spleen Protocol

Surgery News - December 2007

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