Laparoscopically assisted vs. open colectomy for colon cancerWritten by Ivo Mitsiev at in "Minimally Invasive Surgery" and also in "Surgical Oncology", "Colorectal Surgery".
This is a somehow old (mid 2004) but nevertheless important multicenter trial which aroused my interest due to the fact that I do laparoscopically (hand)assisted colectomies.
The conclusion is:
...the rates of recurrent cancer were similar after laparoscopically assisted colectomy and open colectomy, suggesting that the laparoscopic approach is an acceptable alternative to open surgery for colon cancer.
Though, "no advantage of laparoscopically assisted surgery was evident with respect to either all stages of cancer or high-risk subgroups".
The collecting of data for the trial began 1994. Therefore the new, hand assisted approach in the laparoscopic surgery, could not be considered.
My own experience (and subjective, personal feeling) shows big advantages of the hand assisted laparoscopy over the "classical" laparocopic way:
- The lack of the tactile evaluation could not be discussed as a disadvantage of the laparoscopy compared to the open operations anymore. We all have read and led enough of this discussions.
- The five(!) fingers and a palm inside, could not be substituted even by five trocars.
- The blunt preparation with the fingers is once again available.
- The overall duration of the operations is lower.
Therefore a comparison of the laparoscopically hand assisted vs. open colectomy may show an advantage of the laparoscopic approach over the open surgery.