Helping hand of hybrid surgery benefits colorectal patients

Apr 15, 2009

Despite rapid strides in minimally invasive surgical techniques -- most notably, laparoscopy -- traditional open surgery remains the most common surgical option across the United States for people with diseases of the rectum and colon.

A newer, third option is a hybrid -- hand-assisted laparoscopic (HALS). The approach is safe and effective and compares favorably with standard laparoscopy, according to a team of colorectal surgical specialists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center in their study published in a recent issue of the .

"Laparoscopy offers clear benefits to patients compared with open surgery, including a dramatically smaller incision, less pain and shorter recovery time. But bowel surgery can be highly complex, so sometimes a human hand is helpful," says Dr. Toyooki Sonoda, the lead author of the study, a surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and assistant professor of clinical surgery at Weill Cornell Medical College.

Patients with ulcerative colitis, Crohn's disease, diverticulitis or colorectal cancer may be candidates for partial or total removal of the colon or rectum (colectomy or proctocolectomy). Increasingly, and especially at leading medical centers like NewYork-Presbyterian/Weill Cornell, these life-saving procedures are performed laparoscopically.

Dr. Sonoda explains that there are two ways to perform laparoscopic bowel surgery:

* Standard laparoscopic surgery (SLS), using a small "keyhole" incision through which a small camera and specialized instruments are inserted and manipulated inside the body.

* Hand-assisted laparoscopic surgery (HALS), involving a slightly larger incision at the start of the operation -- one just large enough to allow for the insertion of the hand, which then works in tandem with laparoscopic instruments in removing and repairing bowel tissue.

Earlier studies have shown that short-term outcomes were similar between the two procedures. Now, Dr. Sonoda and his co-authors are the first to report that the two techniques have similar long-term safety profiles as well. Both are associated with very low rates of wound infection, hernia, adhesions and small-bowel obstruction -- the most common post-operative complications of traditional open intestinal surgery.

The researchers had previously taken part in a multi-institutional, randomized, controlled study that demonstrated that the hand-assisted version of the procedure led to time savings in the OR of half an hour for partial removal of the colon and a full hour for total colectomy compared with standard laparoscopy. One reason for this, says Dr. Sonoda, could be that HALS gives surgeons tactile feeling, including the sensation of depth, that helps facilitate various surgical maneuvers.

"We're committed to providing the best possible surgical results for our patients," says Dr. Jeffrey Milsom, the study's senior author. Dr. Milsom is section chief of colon and rectal surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and the Jerome J. DeCosse, M.D., Professor of Colon & Rectal Surgery, and professor of surgery at Weill Cornell Medical College. "The hand-assisted approach has been a valuable addition to our arsenal of surgical treatments."

Dr. Milsom advises patients with bowel disease to discuss all three options -- SLS, HALS and open surgery -- with their surgeon to see which one is most appropriate for them.

Source: New York- Presbyterian Hospital (news : web)

Explore further: Twitter increasingly used to share urological meeting info

add to favorites email to friend print save as pdf

Related Stories

Crohn's disease surgeries make steady advances

Nov 18, 2008

Thousands of Americans suffering from the chronic inflammatory bowel condition known as Crohn's disease are leading longer, healthier lives due to innovative new surgeries, according to experts at NewYork-Presbyterian Hospital/Weill ...

Gallbladder removed without external incisions

Jul 28, 2008

In April of last year, surgeons at NewYork-Presbyterian Hospital/Columbia University Medical Center made headlines by removing a women's gallbladder through her uterus using a flexible endoscope, aided by several external ...

Heart valves implanted without open-heart surgery

Jan 07, 2009

An innovative approach for implanting a new aortic heart valve without open-heart surgery is being offered to patients at NewYork-Presbyterian Hospital/Columbia University Medical Center. Known as the PARTNER (Placement of ...

Recommended for you

Exploring 3-D printing to make organs for transplants

Jul 30, 2014

Printing whole new organs for transplants sounds like something out of a sci-fi movie, but the real-life budding technology could one day make actual kidneys, livers, hearts and other organs for patients ...

High frequency of potential entrapment gaps in hospital beds

Jul 30, 2014

A survey of beds within a large teaching hospital in Ireland has shown than many of them did not comply with dimensional standards put in place to minimise the risk of entrapment. The report, published online in the journal ...

Key element of CPR missing from guidelines

Jul 29, 2014

Removing the head tilt/chin lift component of rescue breaths from the latest cardiopulmonary resuscitation (CPR) guidelines could be a mistake, according to Queen's University professor Anthony Ho.

Burnout impacts transplant surgeons (w/ Video)

Jul 28, 2014

Despite saving thousands of lives yearly, nearly half of organ transplant surgeons report a low sense of personal accomplishment and 40% feel emotionally exhausted, according to a new national study on transplant surgeon ...

User comments : 0