Handoscopic surgery: a prospective multicenter trial of a minimally invasive technique for complex abdominal surgery

Meyers, William C., Foley, David P., Sandor, Andras, Litwin, Demetrius E. M., Callery, Mark P., Yood, Steven M., Gagner, Michel, Garcia, Antonio, Milson, Jeffrey W., Naitoh, Tekeshi, Gerhart, Clark D, Feig, Barry, Madary, A, Mansfield, P, Foley, Eugene, Miller, Anna, Schirmer, Bruce, Fitzgibbons, Robert, Lowham, Anthony, Memon, Muhammed Ashraf, Wasselle, Joseph, Branum, Gene, Chalfant, William P., Dempsey, Daniel T, Duh, Quan-Yung, Holzman, Michael, Horgon, Santiago, Pellegrini, Carlos A., Sinanan, Mika, Hunter, John D., Katkhouda, Namir, Soliman, Hesham, Andersen, Amy, Mahvi, David, Nakada, Stephen, McIntyre, Robert, Steigman, Greg, Petelin, Joseph, Petro, Anthony, Voyles, Carl R., Soper, Nathaniel, Stanley, Mary, Stevens, Joyce, Way, Lawrence W, Eliadi, Carol, Iannacchione, Mary Ann and Saye, William B. (1999) Handoscopic surgery: a prospective multicenter trial of a minimally invasive technique for complex abdominal surgery. JAMA Surgery, 134 5: 477-485. doi:10.1001/archsurg.134.5.477


Author Meyers, William C.
Foley, David P.
Sandor, Andras
Litwin, Demetrius E. M.
Callery, Mark P.
Yood, Steven M.
Gagner, Michel
Garcia, Antonio
Milson, Jeffrey W.
Naitoh, Tekeshi
Gerhart, Clark D
Feig, Barry
Madary, A
Mansfield, P
Foley, Eugene
Miller, Anna
Schirmer, Bruce
Fitzgibbons, Robert
Lowham, Anthony
Memon, Muhammed Ashraf
Wasselle, Joseph
Branum, Gene
Chalfant, William P.
Dempsey, Daniel T
Duh, Quan-Yung
Holzman, Michael
Horgon, Santiago
Pellegrini, Carlos A.
Sinanan, Mika
Hunter, John D.
Katkhouda, Namir
Soliman, Hesham
Andersen, Amy
Mahvi, David
Nakada, Stephen
McIntyre, Robert
Steigman, Greg
Petelin, Joseph
Petro, Anthony
Voyles, Carl R.
Soper, Nathaniel
Stanley, Mary
Stevens, Joyce
Way, Lawrence W
Eliadi, Carol
Iannacchione, Mary Ann
Saye, William B.
Title Handoscopic surgery: a prospective multicenter trial of a minimally invasive technique for complex abdominal surgery
Journal name JAMA Surgery   Check publisher's open access policy
ISSN 2168-6254
2168-6262
Publication date 1999-05-01
Sub-type Article (original research)
DOI 10.1001/archsurg.134.5.477
Open Access Status DOI
Volume 134
Issue 5
Start page 477
End page 485
Total pages 9
Place of publication Chicago, IL, United States
Publisher American Medical Association
Language eng
Formatted abstract
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.
Keyword Laparoscopic colorectal surgery
Gastroesophageal reflux
Splenectomy
Colectomy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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