Hand-assisted laparoscopic surgery: experience with an original technique

INTRODUCCION: Hand-assisted laparoscopic colorectal surgery (HALS) is an alternative to straight laparoscopic approach (SL) that requires the use of a specific device to maintain the pneumoperitoneum. Our group has described an original double glove technique to replace it. Our purpose was to compar...

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Detalles Bibliográficos
Autores principales: Vaccaro, Carlos, Gonzalez, Marcos, Ruffa, Tatiana, Campana, Juan Pablo, Mentz, Ricardo, Poggi, Catalina, Rubinstein, Fernando, Marcello, Peter
Formato: Artículo revista
Lenguaje:Español
Publicado: Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2022
Materias:
colorectal surgery
laparoscopy
outcomes
cirugia colorrectal
laparoscopia
resultados
cirurgia colorretal
Acceso en línea:https://revistas.unc.edu.ar/index.php/med/article/view/35412
Aporte de:
Revista de la Facultad de Ciencias Médicas de Córdoba de Universidad Nacional de Córdoba
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institution Universidad Nacional de Córdoba
institution_str I-10
repository_str R-327
container_title_str Revista de la Facultad de Ciencias Médicas de Córdoba
language Español
format Artículo revista
topic colorectal surgery
laparoscopy
outcomes
cirugia colorrectal
laparoscopia
resultados
cirurgia colorretal
laparoscopia
resultados
spellingShingle colorectal surgery
laparoscopy
outcomes
cirugia colorrectal
laparoscopia
resultados
cirurgia colorretal
laparoscopia
resultados
Vaccaro, Carlos
Gonzalez, Marcos
Ruffa, Tatiana
Campana, Juan Pablo
Mentz, Ricardo
Poggi, Catalina
Rubinstein, Fernando
Marcello, Peter
Hand-assisted laparoscopic surgery: experience with an original technique
topic_facet colorectal surgery
laparoscopy
outcomes
cirugia colorrectal
laparoscopia
resultados
cirurgia colorretal
laparoscopia
resultados
author Vaccaro, Carlos
Gonzalez, Marcos
Ruffa, Tatiana
Campana, Juan Pablo
Mentz, Ricardo
Poggi, Catalina
Rubinstein, Fernando
Marcello, Peter
author_facet Vaccaro, Carlos
Gonzalez, Marcos
Ruffa, Tatiana
Campana, Juan Pablo
Mentz, Ricardo
Poggi, Catalina
Rubinstein, Fernando
Marcello, Peter
author_sort Vaccaro, Carlos
title Hand-assisted laparoscopic surgery: experience with an original technique
title_short Hand-assisted laparoscopic surgery: experience with an original technique
title_full Hand-assisted laparoscopic surgery: experience with an original technique
title_fullStr Hand-assisted laparoscopic surgery: experience with an original technique
title_full_unstemmed Hand-assisted laparoscopic surgery: experience with an original technique
title_sort hand-assisted laparoscopic surgery: experience with an original technique
description INTRODUCCION: Hand-assisted laparoscopic colorectal surgery (HALS) is an alternative to straight laparoscopic approach (SL) that requires the use of a specific device to maintain the pneumoperitoneum. Our group has described an original double glove technique to replace it. Our purpose was to compare perioperative outcomes of patients undergoing HALS using this original technique vs SL. METHODS: Retrospective review of a prospective database including patients who underwent elective laparoscopic colorectal resections between 2004 to 2020 at the Hospital Italiano, Argentina. Logistic regression analysis, propensity score matching, and inverse probability weighting were used to estimate adjusted treatment effects for perioperative outcomes. RESULTS: HALS (n=458) and SL (n=1692) cases were demographically similar. HALS was associated with a shorter operative time (170.3 vs 206.9 minutes, p<0.001). Such difference was even more pronounced in obese (44.1 min), large patients (37.5 min), complex procedures (33.8 min) and surgeries carried out by non-trained surgeons (57,6 vs 31,6 minutes, p<0.001). Hand-assisted was associated with a lower conversion rate (5% vs 9.9%, p<0.001) with an adjusted odds ratio of 0.45 (95%CI 0.28-0.73). No difference in hospital stay, morbidity, and readmission rates was found. CONCLUSIONS: HALS with double-glove technique is comparable to SL in terms of postoperative outcomes keeping reduced operative time and conversion rates, especially in obese patients undergoing complex procedures.    
publisher Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
publishDate 2022
url https://revistas.unc.edu.ar/index.php/med/article/view/35412
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first_indexed 2024-09-03T21:03:15Z
last_indexed 2024-09-03T21:03:15Z
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spelling I10-R327-article-354122022-08-19T21:47:05Z Hand-assisted laparoscopic surgery: experience with an original technique Cirugía colorrectal laparoscópica mano asistida: experiencia con una técnica original Cirurgia colorretal laparoscópica mão assistida: experiência com uma técnica original Vaccaro, Carlos Gonzalez, Marcos Ruffa, Tatiana Campana, Juan Pablo Mentz, Ricardo Poggi, Catalina Rubinstein, Fernando Marcello, Peter colorectal surgery laparoscopy outcomes cirugia colorrectal laparoscopia resultados cirurgia colorretal laparoscopia resultados INTRODUCCION: Hand-assisted laparoscopic colorectal surgery (HALS) is an alternative to straight laparoscopic approach (SL) that requires the use of a specific device to maintain the pneumoperitoneum. Our group has described an original double glove technique to replace it. Our purpose was to compare perioperative outcomes of patients undergoing HALS using this original technique vs SL. METHODS: Retrospective review of a prospective database including patients who underwent elective laparoscopic colorectal resections between 2004 to 2020 at the Hospital Italiano, Argentina. Logistic regression analysis, propensity score matching, and inverse probability weighting were used to estimate adjusted treatment effects for perioperative outcomes. RESULTS: HALS (n=458) and SL (n=1692) cases were demographically similar. HALS was associated with a shorter operative time (170.3 vs 206.9 minutes, p<0.001). Such difference was even more pronounced in obese (44.1 min), large patients (37.5 min), complex procedures (33.8 min) and surgeries carried out by non-trained surgeons (57,6 vs 31,6 minutes, p<0.001). Hand-assisted was associated with a lower conversion rate (5% vs 9.9%, p<0.001) with an adjusted odds ratio of 0.45 (95%CI 0.28-0.73). No difference in hospital stay, morbidity, and readmission rates was found. CONCLUSIONS: HALS with double-glove technique is comparable to SL in terms of postoperative outcomes keeping reduced operative time and conversion rates, especially in obese patients undergoing complex procedures.     INTRODUCCIÓN: La cirugía colorrectal laparoscópica mano asistida (CLMA) es un abordaje alternativo a la laparoscopia directa (LD) que requiere de un dispositivo específico para mantener el neumoperitoneo. Nuestro grupo describió una técnica original de doble guante como alternativa a este dispositivo. El objetivo del presente trabajo fue analizar los resultados de esta técnica comparándola con la técnica de LD.  MÉTODOS: Se analizó una serie consecutiva de pacientes sometidos a cirugías colorrectales laparoscópicas entre 2004 y 2020 en el Hospital Italiano de Bs, As, Argentina. Se realizó un modelo de regresión múltiple de selección progresiva y apareamiento por puntaje de propensión para analizar los resultados perioperatorios. RESULTADOS: Los casos de CLMA (n=458) y LD (n=1692) fueron demográficamente similares. CLMA se asoció a un menor tiempo operatorio (170,3 vs 206,9 minutos, p<0.001). Dicha reducción fue más marcada en obesos (44.1 min), pacientes grandes (37.5 min), cirugías complejas (33.8 min) y en procedimientos realizados por cirujanos no entrenados (57,6 vs 31,6 minutos, p<0.001). CLMA resultó tener menor índice de conversión (5% vs 9.9%, p<0.001) con una razón de probabilidades ajustada de 0,45. No se hallaron diferencias en cuanto a estadía hospitalaria, morbimortalidad y readmisión. CONCLUSIÓN: CLMA con doble guante es comparable a la LD manteniendo un tiempo operatorio reducido y bajo índice de conversión, particularmente en pacientes obesos sometidos a procedimientos complejos.    INTRODUÇÃO: A cirurgia colorretal laparoscópica assistida pela mão (CLMA) é uma abordagem alternativa para a laparoscopia direta (LD) que requer um dispositivo específico para manter o pneumoperitônio. Nosso grupo descreveu uma técnica original de luva dupla como alternativa a esse dispositivo. O objetivo do presente trabalho foi analisar os resultados desta técnica comparando-a com a técnica LD. MÉTODOS: Uma série consecutiva de pacientes submetidos a cirurgias colorretais laparoscópicas entre 2004 e 2020 no Hospital Italiano de Bs, As, Argentina foi analisada. Um modelo de regressão múltipla de seleção progressiva e correspondência de escore de propensão foi realizado para analisar os resultados perioperatórios. RESULTADOS: Os casos de CLMA (n = 458) e LD (n = 1692) foram demograficamente semelhantes. CLMA foi associado a um tempo operatório mais curto (170,3 vs 206,9 minutos, p <0,001). Essa redução foi mais acentuada em obesos (44,1 min), pacientes grandes (37,5 min), cirurgias complexas (33,8 min) e em procedimentos realizados por cirurgiões não treinados (57,6 vs 31,6 minutos, p <0,001). CLMA acabou tendo uma taxa de conversão mais baixa (5% vs 9,9%, p <0,001) com um odds ratio ajustado de 0,45. Não foram encontradas diferenças em termos de internação, morbimortalidade e readmissão. CONCLUSÃO: CLMA com luvas duplas é comparável ao LD, mantendo um tempo operatório reduzido e uma baixa taxa de conversão, principalmente em pacientes obesos submetidos a procedimentos complexos.   Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2022-06-06 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion text texto texto text/html application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/35412 10.31053/1853.0605.v79.n2.35412 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 79 No. 2 (2022); 150-155 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 79 Núm. 2 (2022); 150-155 Revista da Faculdade de Ciências Médicas de Córdoba; v. 79 n. 2 (2022); 150-155 1853-0605 0014-6722 10.31053/1853.0605.v79.n2 spa https://revistas.unc.edu.ar/index.php/med/article/view/35412/37687 https://revistas.unc.edu.ar/index.php/med/article/view/35412/37748 Derechos de autor 2022 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0

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