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Handoscopic Surgery
A Prospective Multicenter Trial of a Minimally Invasive Technique for Complex Abdominal Surgery
Southern Surgeons' Club Study Group
Arch Surg. 1999;134:477-485.
Hypothesis We hypothesized that hand-assisted laparoscopic surgery (a new technique that involves a surgeon's hand passing through a pneumoperitoneum-protecting sleeve device and assisting in laparoscopic surgery) is feasable and outcomes are comparable to purely laparoscopic procedures in selected cases.
Design A prospective, multicenter, nonrandomized, noncontrolled study was conducted with the participation of expert laparoscopic surgeons.
Setting Academic and community medical centers in 16 states.
Patients Any patient 18 years or older requiring abdominal surgery and determined to be suitable for laparoscopic surgery.
Main Outcome Measures Incision size, duration of the procedure, conversion rate to an open technique, detection of subtle disease, return of bowel function, length of hospital stay, complication rate, and subjective evaluation.
Results The device was used in 58 patients for 24 different procedures, most commonly during colectomy (n=21) and splenectomy (n=7). Twenty-two percent of cases required conversion to open technique because of failure to maintain pneumoperitoneum or failure to complete the anticipated operation by this method. Average incision size was 7.6 cm. Mean duration of all procedures was 223 minutes (range, 110-415 minutes) and for nonconverted procedures was 178 minutes (range, 65-540 minutes). Preoperatively undetectable, subtle disease was palpated in 14 patients (24%). Mean length of hospital stay for all patients was 7.9 days and for the nonconverted group was 6.7 days. Twenty-four percent of patients developed complications, most commonly either wound complications (n=4) or prolonged ileus (n=3). In 58% of cases, surgeons thought that the technique shortened surgery, and 88% of surgeons found the technique "helpful" in all the completed procedures.
Conclusions This technique seems to be a useful tool in the management of cases that either are too complex or take too long to be managed with purely minimally invasive techniques. To further define the potential benefits of this technique in selected procedures, prospective randomized trials are needed.
The members of the Southern Surgeons' Club Study Group are as follows: William C. Meyers, MD, David P. Foley, MD, Andras Sandor, MD, Demetrius E. M. Litwin, MD, Mark P. Callery, MD, and Steven M. Yood, MD, University of Massachusetts Medical School, Worcester; Michel Gagner, MD (formerly with the Cleveland Clinic Foundation), Antonio Garcia, MD, Jeffrey W. Milson, MD, and Tekeshi Naitoh, MD, Mt Sinai Medical Center, New York, NY; Clark D. Gerhart, MD, private practice, Hazleton, Pa; Barry Feig, MD, Alice Madary, RN, and Paul Mansfield, MD, University of Texas M. D. Anderson Cancer Center, Houston; Eugene Foley, MD, Anna Miller, RN, and Bruce Schirmer, MD, University of Virginia Health Science Center, Charlottesville; Robert Fitzgibbons, Jr, MD, Anthony Lowham, MD, and Muhammed Ashraf Memon, MD, Creighton University School of Medicine, Omaha, Neb; Joseph Wasselle, MD, Holmes Regional Medical Center, Melbourne, Fla; Gene Branum, MD, Atlanta VA Hospital, Decatur, Ga; William P. Chalfant III, MD, Cabarrus Memorial Hospital, Concord, NC; Daniel T. Dempsey, MD, Temple University Hospital, Philadelphia, Pa; Quan-Yung Duh, MD, VA Medical Center, San Francisco, Calif; Michael Holzman, MD, Vanderbilt University Medical School, Nashville, Tenn; Santiago Horgon, MD, Carlos A. Pellegrini, MD, and Mika Sinanan, MD, University of Washington, Seattle; John D. Hunter, MD, Emory Clinic, Atlanta, Ga; Namir Katkhouda, MD, and Hesham Soliman, MD, University of California Healthcare Consultation Center, Los Angeles; Amy Andersen, MS, David Mahvi, MD, and Stephen Nakada, MD, University of Wisconsin Hospital, Madison; Robert McIntyre, MD, and Greg Steigman, MD, University of Colorado Health Center, Denver; Joseph Petelin, MD, Shawnee Mission Medical Center, Shawnee Mission, Kan; Anthony Petro, MD, and Carl R. Voyles, MD, Mississippi Baptist Medical Center, Jackson; Nathaniel Soper, MD, Washington University, St Louis, Mo; Mary Stanley, MD, Medical Center of Central Massachusetts; Joyce Stevens, MS; Lawrence W. Way, MD, University of California at San Francisco Medical School; Carol Eliadi, RN, University of Massachusetts Medical School, Worcester; Mary Ann Iannacchione, RN, Duke University Medical Center, Durham, NC; William B. Saye, MD, Advanced Laparoscopic Training Center, Marietta, Ga.
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