Technical Proficiency in Hand-Assisted Laparoscopic Colon and Rectal Surgery

Pendlimari, Rajesh; Holubar, Stefan D.; Dozois, Eric J.; Larson, David W.; Pembérton, John H.; Cima, Robert R.

doi:10.1001/archsurg.2011.879

Cited by 40 publications

(5 citation statements)

References 26 publications

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“…On the other hand, we feel that HALS operating times decreased in the year 2012 without any negative consequences. Also, this decrease was similar to those of others who have reported decreased operative times for HALS [11, 12] compared with LAC, while maintaining much of the short-term outcome benefits and morbidity as compared with LAC [13-15]. We should note that, as only 4 patients with middle rectal cancer were included in these series, our experience allows us to emphasize that this surgical technique is indicated for left-sided colonic and upper rectal cancer.…”

Section: Discussionsupporting

confidence: 91%

“…It is important to emphasize that the mean operative time was only 105 minutes in our series (range, 55-85). Also, the trend of the operative time was almost horizontal, suggesting that HALS colorectal resections for left-sided large bowel cancer is not a big technical challenge for surgeons who are quite familiar with general colorectal surgery techniques and have had general laparoscopic training [11]. On the other hand, we feel that HALS operating times decreased in the year 2012 without any negative consequences.…”

Section: Discussionmentioning

confidence: 96%

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Clinical Outcomes of 103 Hand-Assisted Laparoscopic Surgeries for Left-Sided Colon and Rectal Cancer: Single Institutional Review

et al. 2013

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PurposeThe laparoscopic colectomy is avoided principally because of its technical difficulty, steep learning curve, and increased operative time. Hand-assisted laparoscopic surgery (HALS) is an alternative technique that addresses these problems while preserving the short-term benefits of a laparoscopic colectomy. Our study was aimed to describe the characteristics of patients admitted due to left-sided colon and rectal cancer for HALS.MethodsA prospectively maintained database was used to identify patients who underwent HALS at the Institute of Oncology, Vilnius University, from July 1, 2009, to October 1, 2012.ResultsOne hundred-three HALS colorectal resections were performed. The patients' mean age was 64 ± 13.4 years. There were 46 male and 57 female patients. The body mass index was 27.3 ± 5.8 kg/m2. Forty-three patients (41.8%) had experienced prior abdominal surgery. The mean HALS time was 105 minutes (range, 55-85 minutes). The conversion rate was 2.7% (3/103). The median of return of gastrointestinal function was 2.5 days (range, 2.2-4.5 days). The median length of hospital stay was 9 days. The postoperative complication and mortality rates were 10.7% and 0.97%, respectively. Four incisional hernias (3.9%) were seen at a mean follow-up of 7.0 ± 3.4 months. None of the patients had a trocar or a hand-port site recurrence.ConclusionA HALS colorectal resection is a safe and effective technique, and it provides all the benefits of minimally invasive surgery.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 96%

Clinical Outcomes of 103 Hand-Assisted Laparoscopic Surgeries for Left-Sided Colon and Rectal Cancer: Single Institutional Review

et al. 2013

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“…On the other hand, we feel that HALS operating times decreased in the year 2012 -2013 without any negative consequences. And this decrease would be similar to those of others who have reported decreased operative times for HALS [11,12] compared with LAC, while maintaining much of the short-term outcome benefits and morbidity as compared with LAC [13][14][15]. It should be noted that as only 4 patients with middle rectal cancer were included in these series, our experience allows us to em-phasize that this surgical technique is indicated for left sided colonic and upper rectal cancer.…”

Section: Discussionsupporting

confidence: 85%

“…It is important to emphasize that the mean operative time was only 105 minutes in our series (range, 55 -270). And, the trend of the operative time was almost horizontal, suggesting that HALS colorectal resections for left sided large bowel cancer is not a big technical challenge for surgeons who are quite familiar with general colorectal surgery techniques and have had general laparoscopic training [11]. On the other hand, we feel that HALS operating times decreased in the year 2012 -2013 without any negative consequences.…”

Section: Discussionmentioning

confidence: 84%

Clinical outcomes of 154 hand-assisted laparoscopic surgeries for left sided colon and rectal cancer: single center experience

Dulskas¹,

Samalavičius²,

Gupta³

et al. 2013

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Background / objectiveHALS technique has provided all the benefits of a minimal invasive surgery, is a safe and effective procedure. Our study was aimed to describe characteristics of patients admitted to Institute of Oncology, Vilnius University due to left sided colon and rectal cancer for hand-assisted laparoscopic surgery (HALS), colorectal resections performed, intraoperative, postoperative, incision and trocar site long-term clinical outcomes.Laparoscopic colectomy is avoided because of its technical difficulty, steep learning curve, and increased operative times. Hand-assisted laparoscopic colectomy is an alternative technique that addresses these problems while preserving the short-term benefits of laparoscopic colectomy. Our study was aimed to describe characteristics of patients admitted due to left sided colon and rectal cancer for hand-assisted laparoscopic surgery (HALS), colorectal resections performed, intraoperative, postoperative, incision and trocar site long-term clinical outcomes.MethodsA prospectively maintained database was used to identify all patients who underwent HALS for left sided colon and rectal cancer at the Institute of Oncology, Vilnius University, from July 1, 2009, when HALS using transumbilical handport incision was started, to October 1, 2013.Results154 HALS colorectal resections were performed. The patients’ mean age was 63±11 years. There were 79 male and 75 female patients. BMI was 27.3 ± 5.8 kg/m2. Forty-four patients (28.5%) have experienced a prior abdominal surgery. The mean HALS time is 105 minutes (55–185). Conversion rate was 3.2% (5/154). The average number of lymph nodes harvested was 15 (3–49). The median of return of gastrointestinal function was 2.5 days (2.2–4.5). The median length of hospital stay was 6.8days (3 – 31). Postoperative complication rate was 9.7%. Two patients (1.3%) demanded explorative laparotomy. Postoperative mortality rate was 0.65%. There were 4 (2.6%) incisional hernias seen on a mean follow-up of 7.0±3.4 months.ConclusionsHALS technique has provided all the benefits of a minimal invasive surgery. HALS colorectal resection is a safe and effective procedure.Keywords: Hand assisted laparoscopic surgery (HALS); Laparoscopic colectomy; Outcomes.Ranka asistuojamų 154 laparoskopinių kolektomijų dėl kairės pusės storosios ir tiesiosios žarnos vėžio rezultatai: vieno centro patirtis Įvadas/ tikslasHALS technika apima visus minimaliai invazyvios chirurgijos privalumus, yra saugi ir efektyvi. Šioje studijoje prospektyviai nagrinėjama pacientų, kuriems dėl kairės pusės storosios ar tiesiosios žarnos vėžio Vilniaus universiteto Onkologijos institutebuvo atlikta ranka asistuojama laparoskopinė kolektomija (HALS), demografiniai rodikliai, procedūros pobūdis, intraoperaciniai ir pooperaciniai duomenys. Pasaulyje kas dešimta kolektomija atliekama laparoskopiškai. Laparoskopija nėra dažna dėl techninių sunkumų, ilgos mokymosi kreivės, ilgesnės operacijos trukmės. Ranka asistuojama laparoskopinė kolektomija minėtų trūkumų neturi.Ligoniai ir metodaiProspektyviai buvo išanalizuotas 154 pacientas, kuriam 2009 07 01 – 2013 10 01 metais Vilniaus universiteto Onkologijos institute buvo atlikta HALS operacija dėl kairės pusės storosios ar tiesiosos žarnos vėžio.RezultataiAtlikta 154 HALS kolorektalinės rezekcijos. Pacientų amžius – 63±11 metai. Operuota 79 vyrai ir 75 moterys. KMI buvo 27,3 ± 5,8 kg/m2. 44 pacientams (28,6 %), anamnezės duomenimis, buvo atliktos pilvo operacijos. Vidutinė operacijos trukmė – 105 minutės (55–185). Konversijų dažnis – 3,2 % (5/154). Vidutinis pašalintų limfmazgių skaičius buvo 15 (3–49). Gastrointestinė funkcija atsitaisė per 2,5 dienos (2,2–4,5). Pooperacinio periodo trukmė – 6,8 dienos (3–31). 9,7 % atvejų pasitaikė komplikacijų. Dviem pacientams (1,3 %) atlikta relaparotomija. Pooperacinio mirtingumo dažnis buvo 0,65 %. Keturiems pacientams (2,6 %) diagnozuotos pooperacinės išvaržos (stebėjimo vidurkis 7,0±3,4 mėn.).IšvadosHALS technika apima visus minimaliai invazyvios chirurgijos privalumus, yra saugi ir efektyvi.Reikšminiai žodžiai: Ranka asistuojama laparoskopinė chirurgija (HALS), laparoskopinė kolektomija, baigtys.

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“…These findings are consistent across surgical fields as demonstrated in a colorectal study that attempted to determine when surgeons performing hand-assisted laparoscopic colon and rectal surgery transitioned from their “learning curve” to their “skilled period”. This study estimated that the transition occurred at approximately 105 cases – and furthermore, outcomes continued to improve beyond this number 15 .…”

Section: Discussionmentioning

confidence: 95%

Assessment of the Male Urethral Reconstruction Learning Curve

Faris

Myers

Voelzke

et al. 2016

Urology

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Objective To evaluate the urethroplasty learning curve. Published success rates of urethral reconstruction for urethral stricture disease are high even though these procedures can be technically demanding. It is likely that success rates improve with time although a learning curve for urethral reconstruction has never been established. Materials/Methods We retrospectively reviewed anterior urethroplasties from a prospectively maintained multi-institutional database. Success was analyzed at the 18-month mark in all patients and defined as freedom from secondary operation for stricture recurrence. A multivariate logistic regression was performed for outcomes versus time since fellowship and case number. Results A total of 613 consecutive cases from six surgeons were analyzed, with a functional success rate of 87.3%. The success for bulbar urethroplasties was higher than for penile urethroplasties (88.2% vs 78.3%, p = 0.0116). The success of anastomotic repairs was higher than for substitution repairs (95.0% vs 82.4%, p = 0.0001). There was a statistically significant trend towards improved outcomes with increasing number of cases (p = 0.0422), which was most pronounced with bulbar repairs. There was no statistical improvement in penile repairs over time. The case number to reach proficiency (> 90% success), was approximately 100 cases for all types of reconstruction were considered and 70 cases for bulbar urethroplasties. There were statistical differences in success rates among the participating surgeons (p = 0.0014). Complications decreased with time (p = 0.0053). Conclusions This study shows success rates of anterior urethral reconstruction improve significantly with surgeon experience. Proficiency occurs after approximately 100 cases.

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Technical Proficiency in Hand-Assisted Laparoscopic Colon and Rectal Surgery

Abstract: To determine how many cases are required to achieve technical proficiency for hand-assisted laparoscopic surgery (HALS).

Cited by 40 publications

References 26 publications

Clinical Outcomes of 103 Hand-Assisted Laparoscopic Surgeries for Left-Sided Colon and Rectal Cancer: Single Institutional Review

Clinical Outcomes of 103 Hand-Assisted Laparoscopic Surgeries for Left-Sided Colon and Rectal Cancer: Single Institutional Review

Clinical outcomes of 154 hand-assisted laparoscopic surgeries for left sided colon and rectal cancer: single center experience

Assessment of the Male Urethral Reconstruction Learning Curve

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