Hand-assisted or laparoscopic-assisted approach in colorectal surgery: a systematic review and meta-analysis
Background Evidence of benefits of laparoscopic and laparoscopic-assisted colectomies (LAC) over open procedures in gastrointestinal surgery has continued to accumulate. With its wide implementation, technical difficulties and limitations of LAC have become clear. Hand-assisted laparoscopic surgery...
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| description | Background
Evidence of benefits of laparoscopic and laparoscopic-assisted colectomies (LAC) over open procedures in gastrointestinal surgery has continued to accumulate. With its wide implementation, technical difficulties and limitations of LAC have become clear. Hand-assisted laparoscopic surgery (HALS) was introduced in an attempt to facilitate the transition from open techniques to minimally invasive procedures. Continuing debate exists about which approach is to be preferred, HALS or LAC. Several studies have compared these two techniques in colorectal surgery, but no single study provided evidence which procedure is superior. Therefore, a systematic review was carried out comparing HALS with LAC colorectal resection.
Methods
Eligible studies were identified from electronic databases (Medline, Embase Cochrane) and cross-reference search. The database search, quality assessment, and data extraction were independently performed by two reviewers. Minimal outcome criteria for inclusion were operating time, conversion rate, hospital stay, and morbidity.
Results
Out of 468 studies a total of 13 studies were selected for comprehensive review. Two randomized controlled trials (RCT) and 11 non-RCTs, comprising 1017 patients, met the inclusion criteria. Because of possible clinical heterogeneity two groups of procedures were created: segmental colectomies and total (procto)colectomies. In the segmental colectomy group significant differences in favor of the HALS group were seen in operating time (WMD 19 min) and conversion rate (OR of 0.3 conversions). In the total (procto)colectomy group a significant difference in favor of the HALS group was seen in operating time (WMD 61 min).
Conclusions
This systematic review indicates that HALS provides a more efficient segmental colectomy regarding operating time and conversion rate, particularly accounting for diverticulitis. A significant operating time advantage exists for HALS total (procto)colectomy. HALS must therefore be considered a valuable addition to the laparoscopic armamentarium to avoid conversion and speed up complicated colectomies. |
| doi_str_mv | 10.1007/s00464-008-9857-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2471396</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69314302</sourcerecordid><originalsourceid>FETCH-LOGICAL-c563t-2b3ee330bbe0723d8fa7d5b99f9c1312b4ad726671f9e71f73def0bfb2674e543</originalsourceid><addsrcrecordid>eNp1kc2KFDEUhYMoTjv6AG4kCLqL5q8qFRcDMqgjDLjRdbiVujWTIV0pk6qRfnvTdDOtgptkcb-c3HMOIS8Ffyc4N-8L57rVjPOO2a4xTD8iG6GVZFKK7jHZcKs4k8bqM_KslDtecSuap-RMdFoZ3bUbEq9gGhiUEsqCA02ZRpghp-LTHPxpAPOcE_hbGibqU0wZ_QKRljXfYN59oEDLroJbWIKnGe8D_qJVmW5xAQYTxF0Vek6ejBALvjje5-TH50_fL6_Y9bcvXy8_XjPftGphsleISvG-R26kGroRzND01o7WCyVkr2Ewsm2NGC3Ww6gBR96PvWyNxkarc3Jx0J3XfouDx2nJEN2cwxbyziUI7u_JFG7dTbp3UhuhbFsF3h4Fcvq5YlncNhSPMcKEaS2utarmzGUFX_8D3qU1V7vFSWG11lKrCokD5GuuJeP4sIngbl-kOxTpapFuX6TbW3j1p4XTi2NzFXhzBKB4iGOGyYfywEleczDGVk4euFJHUy3rtOH_f_8NASq4uQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>219444243</pqid></control><display><type>article</type><title>Hand-assisted or laparoscopic-assisted approach in colorectal surgery: a systematic review and meta-analysis</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Aalbers, A. G. J. ; Biere, S. S. A. Y. ; van Berge Henegouwen, M. I. ; Bemelman, W. A.</creator><creatorcontrib>Aalbers, A. G. J. ; Biere, S. S. A. Y. ; van Berge Henegouwen, M. I. ; Bemelman, W. A.</creatorcontrib><description>Background
Evidence of benefits of laparoscopic and laparoscopic-assisted colectomies (LAC) over open procedures in gastrointestinal surgery has continued to accumulate. With its wide implementation, technical difficulties and limitations of LAC have become clear. Hand-assisted laparoscopic surgery (HALS) was introduced in an attempt to facilitate the transition from open techniques to minimally invasive procedures. Continuing debate exists about which approach is to be preferred, HALS or LAC. Several studies have compared these two techniques in colorectal surgery, but no single study provided evidence which procedure is superior. Therefore, a systematic review was carried out comparing HALS with LAC colorectal resection.
Methods
Eligible studies were identified from electronic databases (Medline, Embase Cochrane) and cross-reference search. The database search, quality assessment, and data extraction were independently performed by two reviewers. Minimal outcome criteria for inclusion were operating time, conversion rate, hospital stay, and morbidity.
Results
Out of 468 studies a total of 13 studies were selected for comprehensive review. Two randomized controlled trials (RCT) and 11 non-RCTs, comprising 1017 patients, met the inclusion criteria. Because of possible clinical heterogeneity two groups of procedures were created: segmental colectomies and total (procto)colectomies. In the segmental colectomy group significant differences in favor of the HALS group were seen in operating time (WMD 19 min) and conversion rate (OR of 0.3 conversions). In the total (procto)colectomy group a significant difference in favor of the HALS group was seen in operating time (WMD 61 min).
Conclusions
This systematic review indicates that HALS provides a more efficient segmental colectomy regarding operating time and conversion rate, particularly accounting for diverticulitis. A significant operating time advantage exists for HALS total (procto)colectomy. HALS must therefore be considered a valuable addition to the laparoscopic armamentarium to avoid conversion and speed up complicated colectomies.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-008-9857-4</identifier><identifier>PMID: 18437486</identifier><identifier>CODEN: SUREEX</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Biological and medical sciences ; Colorectal Surgery - adverse effects ; Colorectal Surgery - economics ; Colorectal Surgery - methods ; Colorectal Surgery - mortality ; Gastroenterology ; General aspects ; Gynecology ; Health Care Costs ; Hepatology ; Hospital Mortality ; Humans ; Intestines - physiopathology ; Laparoscopy ; Length of Stay ; Medical sciences ; Medicine ; Medicine & Public Health ; Postoperative Complications ; Proctology ; Recovery of Function ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system ; Time Factors ; Treatment Outcome</subject><ispartof>Surgical endoscopy, 2008-08, Vol.22 (8), p.1769-1780</ispartof><rights>The Author(s) 2008</rights><rights>2008 INIST-CNRS</rights><rights>Springer Science+Business Media, LLC 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c563t-2b3ee330bbe0723d8fa7d5b99f9c1312b4ad726671f9e71f73def0bfb2674e543</citedby><cites>FETCH-LOGICAL-c563t-2b3ee330bbe0723d8fa7d5b99f9c1312b4ad726671f9e71f73def0bfb2674e543</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-008-9857-4$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-008-9857-4$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20543779$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18437486$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aalbers, A. G. J.</creatorcontrib><creatorcontrib>Biere, S. S. A. Y.</creatorcontrib><creatorcontrib>van Berge Henegouwen, M. I.</creatorcontrib><creatorcontrib>Bemelman, W. A.</creatorcontrib><title>Hand-assisted or laparoscopic-assisted approach in colorectal surgery: a systematic review and meta-analysis</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Evidence of benefits of laparoscopic and laparoscopic-assisted colectomies (LAC) over open procedures in gastrointestinal surgery has continued to accumulate. With its wide implementation, technical difficulties and limitations of LAC have become clear. Hand-assisted laparoscopic surgery (HALS) was introduced in an attempt to facilitate the transition from open techniques to minimally invasive procedures. Continuing debate exists about which approach is to be preferred, HALS or LAC. Several studies have compared these two techniques in colorectal surgery, but no single study provided evidence which procedure is superior. Therefore, a systematic review was carried out comparing HALS with LAC colorectal resection.
Methods
Eligible studies were identified from electronic databases (Medline, Embase Cochrane) and cross-reference search. The database search, quality assessment, and data extraction were independently performed by two reviewers. Minimal outcome criteria for inclusion were operating time, conversion rate, hospital stay, and morbidity.
Results
Out of 468 studies a total of 13 studies were selected for comprehensive review. Two randomized controlled trials (RCT) and 11 non-RCTs, comprising 1017 patients, met the inclusion criteria. Because of possible clinical heterogeneity two groups of procedures were created: segmental colectomies and total (procto)colectomies. In the segmental colectomy group significant differences in favor of the HALS group were seen in operating time (WMD 19 min) and conversion rate (OR of 0.3 conversions). In the total (procto)colectomy group a significant difference in favor of the HALS group was seen in operating time (WMD 61 min).
Conclusions
This systematic review indicates that HALS provides a more efficient segmental colectomy regarding operating time and conversion rate, particularly accounting for diverticulitis. A significant operating time advantage exists for HALS total (procto)colectomy. HALS must therefore be considered a valuable addition to the laparoscopic armamentarium to avoid conversion and speed up complicated colectomies.</description><subject>Abdominal Surgery</subject><subject>Biological and medical sciences</subject><subject>Colorectal Surgery - adverse effects</subject><subject>Colorectal Surgery - economics</subject><subject>Colorectal Surgery - methods</subject><subject>Colorectal Surgery - mortality</subject><subject>Gastroenterology</subject><subject>General aspects</subject><subject>Gynecology</subject><subject>Health Care Costs</subject><subject>Hepatology</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Intestines - physiopathology</subject><subject>Laparoscopy</subject><subject>Length of Stay</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Postoperative Complications</subject><subject>Proctology</subject><subject>Recovery of Function</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kc2KFDEUhYMoTjv6AG4kCLqL5q8qFRcDMqgjDLjRdbiVujWTIV0pk6qRfnvTdDOtgptkcb-c3HMOIS8Ffyc4N-8L57rVjPOO2a4xTD8iG6GVZFKK7jHZcKs4k8bqM_KslDtecSuap-RMdFoZ3bUbEq9gGhiUEsqCA02ZRpghp-LTHPxpAPOcE_hbGibqU0wZ_QKRljXfYN59oEDLroJbWIKnGe8D_qJVmW5xAQYTxF0Vek6ejBALvjje5-TH50_fL6_Y9bcvXy8_XjPftGphsleISvG-R26kGroRzND01o7WCyVkr2Ewsm2NGC3Ww6gBR96PvWyNxkarc3Jx0J3XfouDx2nJEN2cwxbyziUI7u_JFG7dTbp3UhuhbFsF3h4Fcvq5YlncNhSPMcKEaS2utarmzGUFX_8D3qU1V7vFSWG11lKrCokD5GuuJeP4sIngbl-kOxTpapFuX6TbW3j1p4XTi2NzFXhzBKB4iGOGyYfywEleczDGVk4euFJHUy3rtOH_f_8NASq4uQ</recordid><startdate>20080801</startdate><enddate>20080801</enddate><creator>Aalbers, A. 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A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c563t-2b3ee330bbe0723d8fa7d5b99f9c1312b4ad726671f9e71f73def0bfb2674e543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Abdominal Surgery</topic><topic>Biological and medical sciences</topic><topic>Colorectal Surgery - adverse effects</topic><topic>Colorectal Surgery - economics</topic><topic>Colorectal Surgery - methods</topic><topic>Colorectal Surgery - mortality</topic><topic>Gastroenterology</topic><topic>General aspects</topic><topic>Gynecology</topic><topic>Health Care Costs</topic><topic>Hepatology</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Intestines - physiopathology</topic><topic>Laparoscopy</topic><topic>Length of Stay</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Postoperative Complications</topic><topic>Proctology</topic><topic>Recovery of Function</topic><topic>Surgery</topic><topic>Surgery (general aspects). 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G. J.</au><au>Biere, S. S. A. Y.</au><au>van Berge Henegouwen, M. I.</au><au>Bemelman, W. A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hand-assisted or laparoscopic-assisted approach in colorectal surgery: a systematic review and meta-analysis</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2008-08-01</date><risdate>2008</risdate><volume>22</volume><issue>8</issue><spage>1769</spage><epage>1780</epage><pages>1769-1780</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><coden>SUREEX</coden><abstract>Background
Evidence of benefits of laparoscopic and laparoscopic-assisted colectomies (LAC) over open procedures in gastrointestinal surgery has continued to accumulate. With its wide implementation, technical difficulties and limitations of LAC have become clear. Hand-assisted laparoscopic surgery (HALS) was introduced in an attempt to facilitate the transition from open techniques to minimally invasive procedures. Continuing debate exists about which approach is to be preferred, HALS or LAC. Several studies have compared these two techniques in colorectal surgery, but no single study provided evidence which procedure is superior. Therefore, a systematic review was carried out comparing HALS with LAC colorectal resection.
Methods
Eligible studies were identified from electronic databases (Medline, Embase Cochrane) and cross-reference search. The database search, quality assessment, and data extraction were independently performed by two reviewers. Minimal outcome criteria for inclusion were operating time, conversion rate, hospital stay, and morbidity.
Results
Out of 468 studies a total of 13 studies were selected for comprehensive review. Two randomized controlled trials (RCT) and 11 non-RCTs, comprising 1017 patients, met the inclusion criteria. Because of possible clinical heterogeneity two groups of procedures were created: segmental colectomies and total (procto)colectomies. In the segmental colectomy group significant differences in favor of the HALS group were seen in operating time (WMD 19 min) and conversion rate (OR of 0.3 conversions). In the total (procto)colectomy group a significant difference in favor of the HALS group was seen in operating time (WMD 61 min).
Conclusions
This systematic review indicates that HALS provides a more efficient segmental colectomy regarding operating time and conversion rate, particularly accounting for diverticulitis. A significant operating time advantage exists for HALS total (procto)colectomy. HALS must therefore be considered a valuable addition to the laparoscopic armamentarium to avoid conversion and speed up complicated colectomies.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>18437486</pmid><doi>10.1007/s00464-008-9857-4</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Abdominal Surgery Biological and medical sciences Colorectal Surgery - adverse effects Colorectal Surgery - economics Colorectal Surgery - methods Colorectal Surgery - mortality Gastroenterology General aspects Gynecology Health Care Costs Hepatology Hospital Mortality Humans Intestines - physiopathology Laparoscopy Length of Stay Medical sciences Medicine Medicine & Public Health Postoperative Complications Proctology Recovery of Function Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Time Factors Treatment Outcome |
| title | Hand-assisted or laparoscopic-assisted approach in colorectal surgery: a systematic review and meta-analysis |
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