Clin Colon Rectal Surg 2006; 19(1): 019-025
DOI: 10.1055/s-2006-939527
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Hand-Assisted Laparoscopic Colectomy: Rational Evolution for Diverticulitis

H. David Vargas1 , 2 , 3
  • 1Tidewater Surgical Specialists, Colorectal Division, Chesapeake, Virginia
  • 2Colon and Rectal Surgery Program, Sentara Careplex Hospital, Hampton, Virginia
  • 3Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia
Further Information

Publication History

Publication Date:
07 April 2006 (online)

ABSTRACT

Laparoscopic technique has proved to be a revolutionary advance in the surgical treatment of disease. However, limits exist regarding its application to colorectal resection as evidenced by the higher conversion rate and longer learning curve seen with colectomy. Conversion remains a complex issue related to multiple factors. One of the factors, inflammatory disease such as diverticulitis, exposes limitations of laparoscopic technique, specifically the absence of tactile sensation and use of one's hand as a surgical instrument. Nonetheless, the clinical benefits of smaller incisions, decreased pain, decreased ileus, and reduced hospitalization and disability make laparoscopic colectomy a compelling surgical option for the treatment of diverticulitis. Hand-assisted technique offers surgeons a practical and rational innovation for conventional laparoscopic colectomy and offers promise for improved feasibility and efficacy for the treatment of diverticulitis.

REFERENCES

  • 1 Almy T P, Howell D A. Diverticula of the colon.  N Engl J Med. 1980;  302 324-331
  • 2 Cohen J L, Welch J P. Diverticular disease. In: Zuidema GD, Yeo CJ, Pemberton JH Shackelford's Surgery of the Alimentary Tract. 5th ed. Vol 4. Philadelphia; WB Saunders 2002: 141-156
  • 3 Wong W D, Wexner S D, Lowry A et al.. Standards Task Force, American Society of Colon and Rectal Surgeons. Practice parameters for sigmoid diverticulitis: supporting documentation, revised.  Dis Colon Rectum. 2000;  43 290-297
  • 4 Mayo W J. Acquired diverticulitis of the large intestine.  Surg Gynecol Obstet. 1907;  5 8-15
  • 5 Hackford A W, Schoetz D J, Coller J A, Veidenheimer M C. Surgical management of complicated diverticulitis.  Dis Colon Rectum. 1985;  28 317-321
  • 6 Sher M E, Agachan F, Bortul M, Nogueras J J, Weiss E G, Wexner S D. Laparoscopic surgery for diverticulitis.  Surg Endosc. 1997;  11 264-267
  • 7 Hoffman G C, Baker J W, Fitchett C W, Vansant J H. Laparoscopic-assisted colectomy. Initial experience.  Ann Surg. 1994;  219 732-743
  • 8 Phillips E H, Franklin M, Carroll B J, Fallas M J, Ramos R, Rosenthal D. Laparoscopic colectomy.  Ann Surg. 1992;  216 703-707
  • 9 Zucker K, Pithcer D E, Martin D T, Ford R S. Laparoscopic-assisted colon resection.  Surg Endosc. 1994;  8 12-18
  • 10 Bruce C J, Coller J A, Murray J J, Schoetz D J, Roberts P L, Rusin L C. Laparoscopic resection for diverticular disease.  Dis Colon Rectum. 1996;  39(supplement) S1-S6
  • 11 Liberman M A, Phillips E H, Carroll B J, Fallas M, Rosenthal R. Laparoscopic colectomy vs traditional colectomy for diverticulitis-outcome and costs.  Surg Endosc. 1996;  10 15-18
  • 12 Lawrence D M, Pasquale M D, Wasser T E. Laparoscopic versus open sigmoid colectomy for diverticulitis.  Am Surg. 2003;  69 499-504
  • 13 Faynsod M, Stamos M J, Arnell T, Borden C, Udani S, Vargas H A. Case-control study of laparoscopic versus open sigmoid colectomy for diverticulitis.  Am Surg. 2000;  66 841-843
  • 14 Dwivedi A, Chahin F, Argawal S et al.. Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease.  Dis Colon Rectum. 2002;  45 1309-1315
  • 15 Senagore A J, Dupree H J, Delaney C P, Dissanake S, Brady K M, Fazio V W. Cost structure of laparoscopic and open sigmoid colectomy for diverticular disease. Similarities and differences.  Dis Colon Rectum. 2002;  45 485-490
  • 16 Benn P L, Wolff B G, Ilstrup D M. Level of anastomosis and recurrent colonic diverticulitis.  Am J Surg. 1986;  151 269-271
  • 17 Schirmer B D. Laparoscopic colon resection.  Surg Clin North Am. 1996;  76 571-583
  • 18 Young-Fadok T M. Laparoscopic colorectal surgery. In: Zuidema GD, Yeo CJ, Pemberton JH Shackelford's Surgery of the Alimentary Tract. 5th ed. Vol 4. Philadelphia; WB Saunders 2002: 204-217
  • 19 Bergamaschi R, Arnaud J P. Anastomosis level and specimen length in surgery for uncomplicated diverticulitis of the sigmoid.  Surg Endosc. 1998;  12 1149-1151
  • 20 Vargas H D, Ramirez R T, Hoffman G C et al.. Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis.  Dis Colon Rectum. 2000;  43 1726-1731
  • 21 Stevenson A RL, Stitz R W, Lumley J W, Fielding G A. Laparoscopically assisted anterior resection for diverticular disease.  Ann Surg. 1998;  227 335-342
  • 22 Schwandner O, Farke S, Fischer F, Eckmann C, Schiedeck T HK, Bruch H P. Laparoscopic colectomy for recurrent and complicated diverticulitis: a prospective study of 396 patients.  Langenbecks Arch Surg. 2004;  389 97-103
  • 23 Thaler K, Baig M K, Berho M et al.. Determinants of recurrence after sigmoid resection for uncomplicated diverticulitis.  Dis Colon Rectum. 2003;  46 385-388
  • 24 Kockerling F, Schneider C R, Scheidbach H, Scheuerlein H, Konrady J. Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study.  Surg Endosc. 1999;  13 567-571
  • 25 Tekkis P P, Senagore A J, Delaney C P. Conversion rates in laparoscopic colorectal surgery.  Surg Endosc. 2005;  19 47-54
  • 26 Schlachta C M, Mamazza J, Seshadri P A, Cadeddu M, Gregoire R, Poulin E C. Defining a learning curve for laparoscopic colorectal resections.  Dis Colon Rectum. 2001;  43 217-222
  • 27 Le Moine M C, Fabre J M, Vacher C, Navarro F, Picot M C, Domergue J. Factors and consequences of conversion in laparoscopic sigmoidectomy for diverticular disease.  Br J Surg. 2003;  90 232-236
  • 28 Marusch F, Gastinger I, Schneider C et al.. Importance of conversion for results obtained with laparoscopic colorectal surgery.  Dis Colon Rectum. 2001;  44 207-216
  • 29 Tekkis P P, Senagore A J, Delaney C P, Fazio V W. Evaluation of the learning curve in laparoscopic colorectal surgery.  Ann Surg. 2005;  242 83-91
  • 30 Hyman N. How much colorectal surgery do general surgeons do?.  J Am Coll Surg. 2002;  194 37-39
  • 31 Agachan F, Joo J S, Sher M, Weiss E G, Nogueras J J, Wexner S D. Laparoscopic colorectal surgery. Do we get faster?.  Surg Endosc. 1997;  11 331-335
  • 32 Ou H. Laparoscopic-assisted mini laparotomy with colectomy.  Dis Colon Rectum. 1995;  38 324-326
  • 33 Mooney M J, Elliott P L, Galapon D B, James L K, Lilac L H, O’Reilly M J. Hand-assisted laparoscopic sigmoidectomy for diverticulitis.  Dis Colon Rectum. 1998;  41 630-635
  • 34 Sjoerdsma W, Meijer D W, Jansen A, Boer K T, Grimbergen C A. Comparison of efficiencies of three techniques for colon surgery.  J Laparoendosc Adv Surg Tech A. 2000;  10 47-53
  • 35 Targarona E M, Gracia E, Garriga J et al.. Prospective randomized trial comparing conventional laparoscopic colectomy with hand-assisted laparoscopic colectomy.  Surg Endosc. 2002;  16 234-239
  • 36 Hand-assisted laparoscopic surgery vs standard laparoscopic surgery for colorectal disease: a prospective randomized trial. HALS Study Group.  Surg Endosc. 2000;  14 896-901
  • 37 Nakajima K, Lee S W, Cocilovo C, Foglia C, Sonoda T, Milsom J W. Laparoscopic total colectomy: hand-assisted versus standard technique.  Surg Endosc. 2004;  18 582-586
  • 38 Rivadeneira D E, Marcello P W, Roberts P L et al.. Benefits of hand-assisted laparoscopic restorative proctocolectomy: a comparative study.  Dis Colon Rectum. 2004;  47 1371-1376
  • 39 Killingback M. Surgical treatment of diverticulitis. In: Fazio VW, Church JM, Delaney CP Current Therapy in Colorectal Surgery. 2nd ed. Philadelphia; Elsevier Mosby 2005: 285-295
  • 40 Vargas H D, Obias V J. Laparoscopic colectomy for diverticulitis: can a hand-assisted technique reduce conversion without increasing morbidity?.  Dis Colon Rectum. 2002;  45 A57 , (Abstract)
  • 41 Vargas H D, Obias V J. Efficacy of hand-assisted laparoscopic colectomy.  Dis Colon Rectum. 2004;  47 A625 , (Abstract)
  • 42 Lee S W, Yoo J, Dujovny N, Sonoda T, Milsom J. Laparoscopic versus hand-assisted colectomy for diverticulitis.  Dis Colon Rectum. 2005;  48 A638 , (Abstract)
  • 43 Chang Y-J, Marcello P W, Rusin L C, Roberts P L, Schoetz D J. Hand-assisted laparoscopic sigmoid colectomy. Helping hand or hindrance?.  Surg Endosc. 2005;  19 656-661

H. David VargasM.D. 

Colorectal Division-Tidewater Surgical Specialists

3205 Churchland Blvd., Chesapeake, VA 23321

Email: dv700@aol.com

    >