EP532 - Hand-Assisted Laparoscopic Surgery (HALS) as an Alternative to Laparoscopic Converted to Open Surgery (LCOS) in Proctectomy Patients.

Purpose/Background: Hand-assisted laparoscopic surgery (HALS) is a surgical approach that offers a hybrid of tactile operative assistance through a hand port while maintaining pneumoperitoneum for laparoscopy. When compared to standard laparoscopic surgery (SLS) it allows for more assistance with retraction, dissection, and hemostasis and has been shown to have reduced operative times. However, the practice of a HALS approach varies among institutions and surgeons. With SLS, operative challenges may require an unplanned laparoscopic conversion to open surgery (LCOS) which can have adverse postoperative outcomes. This study aimed to compare a wide range of perioperative factors and postoperative outcomes between HALS and LCOS in patients undergoing a proctectomy for rectal malignancy.

Methods/Interventions: The latest available American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2022 Targeted Proctectomy Database was used to analyze patients undergoing a proctectomy. From there, 211 patients who underwent an LCOS procedure (LCOS Group) and 801 patients who underwent a HALS procedure (HALS Group) were identified and compared.

Results/Outcomes: Patients with more comorbidities prior to surgery and a higher American Society of Anesthesiologists (ASA) classification or higher level of preoperative tumor staging were more likely to undergo an LCOS. The operative time for an LCOS was found to be significantly longer compared to HALS (341 ± 8.8 versus (vs.) 308 ± 4.4 minutes; p = 0.001). Additionally, those patients who underwent an LCOS procedure experienced higher rates of postoperative septic shock (1.90% vs. 0.50%; p = 0.042), the need for blood transfusion (20.85% vs. 5.99%; p < 0.001), postoperative renal insufficiency (17.06% vs. 7.12%; p < 0.001), and mortality (1.90% vs. 0.37%; p = 0.018). Multivariate logistic regression analysis indicated that undergoing an LCOS was independently associated with an increased risk of postoperative renal insufficiency (Odds ratio (OR) = 2.6259; p < 0.001) and the need for blood transfusion (OR = 4.0486; p < 0.001).

Conclusion/Discussion: We believe this is the first large national database study comparing HALS and LCOS surgical approaches for proctectomies. After accounting for confounding variables, our multivariate logistic regression analysis revealed that the HALS technique in this patient population was associated with better peri- and postoperative outcomes compared to LCOS. Therefore, HALS can be considered a good alternative to SLS or open conversion should the situation arise.

Factors Independently Associated with Renal Insufficiency and Blood Transfusion
Boldface type denotes statistical significance (p < 0.05). *Cases treated with medication. OR, odds ratio; CI, confidence interval; LCOS, laparoscopic converted to open surgery; IDDM, insulin-dependent diabetes mellitus; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease.