Laparoscopic Colorectal Surgery -- Canadian Practice Patterns and the Role of the Hand Assist Device

Objectives: 1) To identify laparoscopic colorectal surgery practice patterns in Canada, 2) To systematically review the literature comparing hand assisted laparoscopic surgery to conventional laparoscopic surgery and 3) To design a randomized controlled trial protocol comparing conventional laparoscopic to hand assisted laparoscopic colorectal resections. Methods: A national cross sectional study was undertaken of Canadian General Surgeons with respect to their practice patterns specific to laparoscopic colorectal surgery. A systematic review comparing Conventional laparoscopic to Hand-Assisted Laparoscopic colorectal resections. A randomized controlled trial protocol with methodological discussions regarding issues in surgical trials was written. Results: The majority of Canadian General Surgeons are offering laparoscopic colorectal resections although the volume per surgeon appears to be low. The main barriers to adoption are operating time and lack of formal minimally invasive surgery training. There were two trials identified for inclusion in the systematic review with a total of 94 subjects with some methodological weaknesses. A potential trend towards decreased conversion to open surgery in the hand assisted group was identified. A protocol is presented for a trial comparing hand assisted to conventional laparoscopic colorectal surgery. Conclusion: A large percentage of Canadian surgeons perform laparoscopic colorectal resections although many perform less than one case per month. The limited number of trials performed and their associated methodological weaknesses and heterogeneity does not allow a reliable assessment of the relative benefits of hand-assisted and conventional laparoscopic resections for colorectal disease. Additional adequately powered and methodologically sound trials are needed to determine if there is a clinically important difference in perioperative outcomes