P. L. Roberts

Hand-assisted laparoscopic sigmoid colectomy: helping hand or hindrance?

BackgroundHand-assisted laparoscopic colectomy has been introduced as an alternative to the standard laparoscopic technique, but it has not yet been established whether it offers the same benefits. Therefore, we compared the outcome of patients undergoing hand-assisted laparoscopic sigmoid resection (HALSR) to that of those undergoing laparoscopic sigmoid resection (LSR).MethodsThe study population comprised a sequential series of consecutive patients undergoing elective laparoscopic sigmoid/left colectomy. Values are reported as mean (range).ResultsThere were 85 LSR patients and 66 HALSR patients, with no differences in patient demographics or diagnoses. There were slight differences in operative time favoring HALSR (LSR 205 min (90–380) vs HALSR 189 min (120–290); p = 0.07), and the extraction incision was larger in the HALSR group (LSR 6.2 cm (3–25) vs HALSR 8.1 cm (7–12); p < 0.01). There was no difference in time for return of bowel function (LSR 2.8 days (1–15) vs HALSR 2.5 days (1–8); p = 0.31) or length of hospital stay (LSR 5.0 days (2–17) vs HALSR 5.2 days (3–22); p = 0.73). Complications were similar in the two groups (LSR 23% vs HALSR 21%), but there were fewer conversions in the hand-assisted group (HALSR 0% vs LSR 13%; p < 0.01).ConclusionsHand-assisted laparoscopic sigmoid resection yields the same outcomes as standard laparoscopic techniques, but with fewer conversions. Hand-assistance is a helpful innovation that may expand the application of laparoscopic colectomy.

Vascular pedicle ligation techniques during laparoscopic colectomy: A prospective randomized trial

BackgroundA variety of devices are available for pedicle ligation during laparoscopic colectomy including vascular staplers, clips, and electrothermal bipolar vessel-sealing devices. This study assesses their speed, reliability, and cost to guide surgeons in their choice for intracorporeal pedicle ligation.MethodsA prospective randomized study comparing laparoscopic vascular staplers and disposable clip appliers (S/C) with the LigaSure Atlas (LIG) was performed during elective right, left, and total colectomy. Cases were stratified by procedure. Failure was defined as any bleeding after proper pedicle ligation.ResultsThe study included 48 S/C patients and 52 LIG patients with no differences in demographics, diagnosis, procedure, number of vessels ligated per procedure, or operative time. Failure occurred for 14 (9.2%) of the 152 vessels ligated in the S/C group, as compared with 5 (3%) of the 169 vessels ligated in the LIG group (p = 0.02). The median blood loss associated with device failure was 50 ml (range, 20–50 ml) in S/C group, as compared with 100 ml (range 25–800 ml) in the LIG group (p = 0.054). Major blood loss attributable to device failure and surgeon error occurred in only one LIG case. The mean cost per case of vessel ligation was significantly less in the LIG group (

Ileocolic resection for acute presentation of Crohn's disease of the ileum.

317 ±

Perirectal abscess in Crohn's disease. Drainage and outcome.

0 vs

Using quality of life scores to help determine treatment: is restoring bowel continuity better than an ostomy?

400 ±

Malignant duodenocolic fistula diagnosed by endoscopy

112; p < 0.001). The cost differences were greatest for total colectomy (LIG =

Intraoperative colonic lavage and primary anastomosis in nonelective colon resection.

317 ±

Vascular ectasia. Diagnosis and treatment by colonoscopy.

0 vs S/C =

What are 30-day postoperative outcomes following splenic flexure mobilization during anterior resection?

565 ±

How Do Web Based Physician Reviews Compare to Industry Standard Metrics

67; p = 0.002).ConclusionDevice failure, although more common in the S/C group, does not result in significant blood loss. The LigaSure Atlas is more cost effective during laparoscopic colectomy, especially total colectomy, and may allow the surgeon more versatility in its application.