EP2001 - Benefit of Hand-Assisted Laparoscopic Sigmoidectomy in the Era of Robotic Surgery

ePoster Presenter(s)

• 

  Alexis Peters, MD

  Resident Physician
  University of Southern California/Los Angeles General Medical Center
  University of Southern California/Los Angeles General Medical Center
  Los Angeles, CA, United States

  Disclosure information not submitted.

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Author(s)

• 

  Anthony Lim, MD (he/him/his)

  Resident Physician
  University of Southern California/Los Angeles General Medical Center
  University of Southern California
  Los Angeles, CA, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• LD

  Li Ding, MD, MPH

  Biostatistician
  University of Southern California
  Los Angeles, California, United States

  Disclosure information not submitted.
• SB

  Sacha Broccard, MD

  Assistant Professor of Clinical Surgery
  University of Southern California
  Los Angeles, California, United States

  Disclosure information not submitted.
• 

  Kyle G. Cologne, MD

  Professor of Surgery
  Keck School of Medicine of the University of Southern California
  Keck School of Medicine of the University of Southern California
  Los Angeles, California, United States

  Disclosure information not submitted.
• JS

  Joongho Shin, MD

  Clinical Associate Professor
  Keck Medicine of USC
  Pasadena, California, United States

  Disclosure information not submitted.
• MD

  Marjun Philip Duldulao, MD

  Los Angles, CA

  Disclosure information not submitted.
• 

  Sarah Choi, MD, MS

  Colorectal Surgeon, Assistant Professor of Clinical Surgery
  Keck Medicine of USC (University of Southern California)
  Los Angeles, California, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• CH

  Christine Hsieh, MD

  Assistant Professor of Clinical Surgery
  Keck School of Medicine, University of Southern California
  Los Angeles, California, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Sang W. Lee, MD

  Professor and Chief of Colon and Rectal Surgery
  Keck School of Medicine of USC
  Los Angeles, California, United States

  Disclosure information not submitted.

Purpose/Background: Sigmoidectomy is a commonly performed surgery for both general and colorectal surgeons, but at times this procedure may be particularly challenging due to inflammation and scarring from diverticular disease. Prior studies have demonstrated benefits of hand-assisted over standard laparoscopy for both sigmoidectomy and total abdominal colectomy in reducing operative time and conversion to open rates, thought to be due to the presence of tactile feedback and improved hand-eye coordination. With the advent of robotic surgery, studies have suggested that the robotic approach offers advantages including lower conversion rates to open surgery, similar or lower rates of postoperative complications, and shorter hospital stay. The aim of this study was to evaluate outcomes of hand-assisted laparoscopic (HAL) compared to robotic-assisted laparoscopic (RAL) sigmoidectomies.

Methods/Interventions: This retrospective cohort study included patients who underwent HAL or RAL sigmoidectomy at a high-volume academic center between 2018 and 2025. Demographic data and perioperative outcomes were collected via electronic medical record review. A power analysis for a two-sample comparison of means was conducted to detect a 15% difference in operative times between groups (two-sided α = 0.05, 80% power, 1:1 allocation). Bivariate and multivariable analyses were performed using SAS 9.4 to evaluate associations between surgical approach and clinical outcomes. Subgroup analyses were performed for patients undergoing sigmoidectomy for diverticulitis.

Results/Outcomes: 66 sigmoidectomies for each approach were identified. Out of the 132 surgeries, 62.1% were conducted for diverticulitis while 35.6% were for malignancy. Of the diverticulitis surgeries, more patients with recurrent diverticulitis were performed by RAL approach (23 vs. 6 cases, p = 0.025). Operative time was significantly longer for RAL compared to HAL (294.2 vs. 138.1 minutes; p = < 0.0001) and RAL approach remained independently associated with increased operative time on multivariable linear regression after adjusting for indication, ASA, and previous abdominal surgery (p = < 0.0001). This finding was amplified within the diverticulitis subgroup, again demonstrating longer operative time for RAL on bivariate analysis (302.0 vs. 146.1 minutes; p = < 0.0001) and multivariable regression (p = < 0.0001) after controlling for ASA, previous abdominal surgeries, presence of complicated diverticulitis, and number of diverticulitis episodes. The RAL approach was independently associated with shorter extraction incision length (mean 5.2 vs. 8.0 centimeters) on adjusted regression analysis for both the total cohort (p = < 0.0001) and diverticulitis subgroup (p = < 0.0001). There were no significant differences found between groups for conversion to open rate, anastomotic leak rate, EBL, LOS, time to ROBF, wound infection rate, or mortality.

Conclusion/Discussion: Outcomes for HAL sigmoidectomy, including for diverticulitis, were similar compared to the RAL approach with shorter operative time, but with longer incision length. Our data suggests that both techniques are safe and effective. While robotic techniques have become increasingly prevalent, hand-assisted laparoscopic surgery remains an attractive approach, particularly in difficult diverticulitis cases, and may help reduce costs and improve efficiency by shortening operative time.

Table 1.
Demographics for included patients, by surgical approach.

Abbreviations: HAL, hand-assisted laparoscopic; RAL, robotic-assisted laparoscopic; BMI, body mass index; ASA, American Society of Anesthesiologists class; DM, diabetes mellitus; HTN, hypertension; IBD, inflammatory bowel disease; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; HD, hemodialysis; PD, peritoneal dialysis; AC, anticoagulation
Table 2.
Results of bivariate analysis and multivariable regression models comparing RAL and HAL sigmoidectomy, including total cohort and diverticulitis subgroup analysis. ​

1. Independent associations when adjusting for indication, ASA, and previous abdominal surgery​

2. Independent associations when adjusting for ASA, previous abdominal surgery, complicated diverticulitis, number of diverticulitis episodes​

Abbreviations: RAL, robotic-assisted laparoscopic; HAL, hand-assisted laparoscopic; EBL, estimated blood loss; LOS, length of stay; IRR, incidence rate ratio; ROBF, return of bowel function; OR, odds ratio​