Laparoscopic sigmoid colectomy is superior to hand-assisted sigmoid colectomy

Since the introduction of laparoscopic colectomy in 1991 a variety of techniques have evolved. The paths of development of have diverged into 2 distinct groups. In one scenario, decreased use of incisions and decreased trauma has included laparoscopic, single port, NOTES, and transanal techniques. The other paradigm has included the use of larger incisions to enable the insertion of a hand. There has been much debate amongst proponents of these various approaches. In the most recent iteration of this controversy Midura and coworkers form the University of Cincinnati published their findings in Surgical Endoscopy. They retrospectively assessed 191 sigmoid colectomies performed by 5 colorectal surgeons between 2010 and 2014. The authors found that laparoscopic surgery was associated with substantially shorter postoperative hospitalization and return of bowel function as compared to either laparoscopic assisted or hand assisted surgery. The authors conclude that “when technically feasible, the straight laparoscopic approach is preferred”. As I have noted in several prior LinkedIn posts, I am always gratified to see my own personal biases confirmed. In this case, senior authors Janice Rafferty and Ian Paquette have certainly helped strengthen my own prejudices. I have employed laparoscopic colorectal surgery since 1991 and have assiduously avoided techniques which require more ports, more incisions or larger incisions. Their study helps me strengthen my convictions.