Pneumoperitoneum In Laparoscopic Surgery Research Articles

Renal implications of pneumoperitoneum in laparoscopic surgery: mechanisms, risk factors, and preventive strategies.

Pneumoperitoneum, which is established for laparoscopic surgery, has systemic implications on the renal system and may contribute to acute kidney injury or postoperative renal dysfunction. Specifically, when the pressure exceeds 10 mmHg, pneumoperitoneum decreases renal blood flow, leading to renal dysfunction and temporary oliguria. The renal effects of pneumoperitoneum stem from both the direct effects of increased intra-abdominal pressure and indirect factors such as carbon dioxide absorption, neuroendocrine influences, and tissue damage resulting from oxidative stress. While pneumoperitoneum can exacerbate renal dysfunction in patients with pre-existing kidney issues, preserving the function of the remaining kidney is crucial in certain procedures such as laparoscopic live donor nephrectomy. However, available evidence on the effects of pneumoperitoneum on renal function is limited and of moderate quality. This review focuses on exploring the pathophysiological hypotheses underlying kidney damage, mechanisms leading to oliguria and kidney damage, and fluid management strategies for surgical patients during pneumoperitoneum.

Evaluation of Open (Hasson's) and Closed (Veress) Technique of Intraperitoneal Access for Creation of Pneumoperitoneum in Laparoscopic Surgery.

Background The creation of pneumoperitoneum is the first step in any laparoscopic surgery. There are various methods of creating pneumoperitoneum which can be divided into open or closed methods. The closed method involves the blind insertion of the Veress needle into the peritoneal cavity. The open technique involves making an incision and then dissecting the fascia to the peritoneal cavity to introduce the cannula under direct vision. This study was conducted to evaluate the safety and efficacy of open (Hasson's) and closed (Veress) techniques of intraperitoneal access for the creation of pneumoperitoneum in laparoscopic surgery. Material and methods The study was conducted in the Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. This was a prospective observational study and a total of 100 patients of laparoscopic surgeries fulfilling inclusion criteria were included in the study - 50 patients in group A undergoing the open method of creating pneumoperitoneum and 50 patients in group B undergoing the closed method of creating pneumoperitoneum were evaluated for the study period of 18 months from October 2020 through June 2022. Results The mean time to create pneumoperitoneum was 5.3 ± 1.41 minutes in the open method and 6.21 ± 1.36 minutes in the closed method. The mean time for umbilical port closure in our study was 7.33 ± 1.66 in the open group and 8.86 ± 2.19 in the closed group. In our study, there was no vascular or visceral injury noted in either of the methods used for the creation of pneumoperitoneum. Post-operative complications were almost equal in both the groups. Conclusions Both open and closed methods of intraperitoneal access are safe and effective for the creation of pneumoperitoneum during abdominal laparoscopy. The open method of creating pneumoperitoneum in laparoscopic surgery is a quicker method for the creation of pneumoperitoneum as compared to the closed method of intraperitoneal access.

Pre-clinical evaluation of the new veress needle+ mechanism on thiel-embalmed bodies: a controlled crossover study - Experimental research.

Eighteen participants (novices, intermediates, and experts) performed in total of 248 insertions in a systematic way on Thiel-embalmed bodies with wide and small bore versions of the conventional VN (VNc) and the VN+. Insertion depth was measured by recording the graduations on the needle under direct laparoscopic vision. Participants graded the bodies and the procedures as lifelike. Overall, a significant reduction (P<0.001) in average insertion depth was found for the VN+ compared to the VNc of 26.0 SD16 mm versus 46.2 SD15mm. The insertion depth difference in the novice group was higher compared to the intermediates and experts (P<0.001). The average insertion depth for both needle types was less (P<0.001) for female participants compared to male. This study indicated that the VN+ significantly reduced the insertion depth in all tested conditions. Whether the difference between female and male performance can be linked to differences in muscle control or arm mass should be further investigated. Useful technical information was gathered from this study to further improve the VN+.

Assessment of open versus closed method of pneumoperitoneum creation in laparoscopic surgery

Background: The concept of open laparoscopy is to eliminate the risks associated with blind insertion of the Veress needle and trocar. The present study was conducted to assess open versus closed method of pneumoperitoneum creation in laparoscopic surgery.Materials &amp; Methods: 74 patients who underwent operative procedure for laparoscopysurgery of both genderswere divided into 2 groups based on method used. Group I patients were of open laparoscopy (Hasson technique) and group II were of Veress needle (closed method). Per operative findings like method of pneumoperitoneum creation and its duration, multiple attempts, incision size, extraperitoneal insufflation, port site bleeding, gas leak, total gas used were recorded. Results: out of 74 patients, males were 46 and females were 28. In group I and group II, the mean size of incision (mm) was 11.2 and 10.4, duration of pneumoperitonium creation (Sec) was 104.2 and 138.4, multiple attempts were seen in 9 and 4, gas leak at port site in 7and 3, port site bleeding in 5 and 2, pre peritoneal insufflation in 0 and 1 and wound infection in 1 and 2 respectively. The difference was significant (P&lt; 0.05).Conclusion: Both methods were comparable interms of time taken to complete the operation and major and minor complications. Thus, open and closed methods of creating pneumoperitoneum in laparoscopic surgery are safe to perform.

Review of Outcomes of Low Verses Standard Pressure Pneumoperitoneum in Laparoscopic Surgery.

Carbon dioxide pneumoperitoneum during laparoscopy changes cardiorespiratory physiology and contributes to post-op pain. We studied outcomes before and after implementing low-pressure pneumoperitoneum QI project. Forty-two patients were insufflated at standard pressures (15mmHg) while 41 were insufflated using low (8-12mmHg) during laparoscopic procedures. These variables were obtained from the patient chart: pain scores, intravenous morphine milligram equivalents (MME), peak inspiratory pressures (PIP), end-tidal CO2 (EtCO2), surgery duration, and patient demographics. The study was conducted after IRB approval. Low-pressure pneumoperitoneum is feasible and the surgeon can increase to 10-12mmHg as needed. The mean post-op IV MME was significantly decreased in the low-pressure group (11.75 ± 10.41) compared to the standard pressure group (17.36 ± 18.1) (t-test, P = .047). Mean peak inspiratory pressures during insufflation were significantly higher for procedures conducted at standard pressure (31.40 ± 4.82) compared to the 8mmHg (24.68 ± 4.19) and 12mmHg (27.33± 3.85) low pressure groups (one-way ANOVA, P < .0001). During insufflation, there was a significant increase in the average EtCO2 in the standard pressure group (42.07 ± 5.60) compared to the 8mmHg low pressure group (37.59 ± 5.05) (ANOVA, P = .0096). Constant flow insufflation was more likely to be performed at low pressure than demand mode (58% v. 33%). Low pressure pneumoperitoneum decreases PIP pressure and CO2 absorption evidenced by lower ETCO2 intra-operatively. Patients have significant improvement in postoperative pain evidenced by decreased narcotics needed. Low pressure pneumoperitoneum using a constant flow insufflator is safe and results in improved patient outcomes.

Valveless Trocar Versus Standard Pneumoperitoneum Insufflation System in Minimally Invasive Surgery: Impact on Postoperative Pain. A Systematic Review and Meta-Analysis.

Background: The benefits of a valid pneumoperitoneum in laparoscopic surgery are counterbalanced by the possible negative effects of increased abdominal pressure and carbon dioxide (CO2) insufflation, which are crucial factors in causing postoperative pain. The purpose of this work is to evaluate the effectiveness of the valveless trocar (VT) insufflation system in decreasing postoperative pain and influencing operative time, compared to a standard insufflation system. Methods: A systematic research was performed using MEDLINE, EMBASE, Central Cochrane Library, and CINAHL Plus for studies published up to June 2020. Randomized controlled trials (RCTs) on adult population evaluating the effects of VT versus a standard insufflation system in laparoscopic surgery and reporting postoperative pain level and operative time were included in the analysis. Data and study quality indicators were extracted independently by 2 authors using a standardized form. Statistical analysis was based on a random effect model, using the inverse variance method. Results: We identified 3 RCTs for a total of 245 patients. The meta-analysis showed a statistically significant reduction in shoulder pain with the use of VT at 24 hours: mean difference (MD) -7.9% (95% confidence interval [95% CI]: -1.29 to 0.29; z = 3.08; P = .002) and a nonstatistically significant increase in operation time: MD 5.80 (95% CI: -8.93 to 20.54; P = .44). Conclusion: Our study suggests a better shoulder pain control at 24 hours postoperation using new-generation VT for laparoscopic surgery compared to standard insufflation system. Weak evidence of increased operating time with the VT was observed considering only two of the three RCTs. PROSPERO registration number: CRD42020191835.

Effect of two different levels of positive end-expiratory pressure (PEEP) on oxygenation and ventilation during pneumoperitoneum for laparoscopic surgery in children: A randomized controlled study.

Positive end-expiratory pressure (PEEP) is used to attenuate the changes in respiratory parameters because of pneumoperitoneum during laparoscopic (LAP) surgery. As the ideal level of PEEP during LAP in children is not known, this study compared the effect of 5- and 10-cm H2O of PEEP on oxygenation, ventilator, and hemodynamic parameters during pediatric LAP. After obtaining approval from the Institute Ethics Committee and written informed parental consent, 30 American Society of Anesthesiologists (ASA) I and II children aged 2-10 years, undergoing LAP were randomized to receive PEEP of 5- or 10-cm H2O during pneumoperitoneum. Baseline hemodynamic and ventilatory parameters, PaO2, and PaCO2 were measured 2 min after tracheal intubation, 2 min and 1 h after pneumoperitoneum, and after deflation of pneumoperitoneum. Oxygenation index, dynamic compliance, and alveolar-arterial oxygen gradient (D (A-a) O2) were calculated at the above-mentioned time points. Data were analyzed using Student's t-test and repeated measures ANOVA with Bonferroni correction. The oxygenation index and D(A-a)O2 decreased in PEEP 5 Group and increased in PEEP 10 Group after pneumoperitoneum, the difference between the two groups being statistically significant (P = 0.001). The dynamic compliance decreased in PEEP 5 Group and increased or remained the same in PEEP 10 Group after pneumoperitoneum, the difference between the two groups being significant (P = 0.001). There were no significant changes in the hemodynamic parameters in the two groups. Use of 10-cm H2O PEEP during pneumoperitoneum in children improves ventilation and oxygenation, without significant hemodynamic changes.

Effects of Laparoscopic Radical Gastrectomy on Peritoneal Micrometastases of Gastric Cancer.

Some reports asserted that the stimulation of ultrasonic scalpel and the persistent state of carbon dioxide (CO2) pneumoperitoneum in laparoscopic surgery may affect the adhesion and invasion of gastric cancer (GC) cells. This study aimed to reveal the effects of laparoscopic radical gastrectomy on peritoneal micrometastases (PM) of GC. Fifty-three patients who underwent laparoscopic radical gastrectomy for GC were enrolled in the study. The expressions of carcinoembryonic antigen (CEA) mRNA and dopa decarboxylase (DDC) mRNA in peritoneal lavage fluid were detected by reverse transcription-polymerase chain reaction. The positive rates of CEA mRNA and DDC mRNA in preoperative peritoneal lavage fluid (pre-CEA, pre-DDC) were compared with those in postoperative lavage fluid (post-CEA, post-DDC). The correlation between the expressions of pre-CEA and pre-DDC and clinicopathologic factors and disease-free survival was analyzed. There was no significant difference in the positive rates of pre-CEA and pre-DDC compared with those of post-CEA and post-DDC (all P>0.05). The positive rates of pre-CEA and pre-DDC increased with the increase of TNM stage, deepening of invasion, lymph node metastasis, and serosal invasion (all P<0.05), but had no correlation with tumor location, size, degree of differentiation, nerve invasion, and vascular invasion (all P>0.05). The disease-free survival in the combined positive patients was lower than that in the negative patients. Laparoscopic radical gastrectomy for GC is safe and feasible, without increasing the risk of PM. The PM of GC may be associated with late tumor stage, deep infiltration, lymph node metastasis, and serosal invasion.

Fast, Easy, and Safe Establishment of Pneumoperitoneum in Laparoscopic Surgery: The Fingertip Technique.

Background and Objectives:There is no consensus on an ideal abdominal entry in laparoscopic surgery; as such, we aimed to assess the feasibility of the fingertip technique for safe entry and the establishment of pneumoperitoneum in transperitoneal laparoscopic surgery.Methods:We prospectively assessed 96 consecutive patients who underwent laparoscopic transperitoneal surgery between December 2018 and September 2019. For all patients, pneumoperitoneum was performed using the fingertip technique, which we recently defined. The duration of time for initial entry, the occurrence of gas leakage, and the complications were evaluated.Results:The median duration of initial entry was 90 (75 – 145) seconds. Pneumoperitoneum was established on the first attempt in all patients. Some events were encountered at the time of implementation of the fingertip technique, such as subcutaneous minor bleeding (5.2%) and gas leakage (4.1%). These events were controlled with cauterization and suturing. There was no visceral or major vascular injury in any patient case.Conclusions:The fingertip technique is a fast, safe, and feasible method for establishing pneumoperitoneum in transperitoneal laparoscopic surgery.

Clinical and Organizational Impact of the AIRSEAL® Insufflation System During Laparoscopic Surgery: A Systematic Review.

Several low-impact laparoscopic strategies have been developed to improve the safety of pneumoperitoneum. We conducted a systematic review to establish the current evidence base for the use of the AIRSEAL® insufflation device for low-pressure pneumoperitoneum in laparoscopic surgery. We searched the literature using several electronic databases, for studies with comparative design published in the English language from January 2010 to April 2020. The population of interest included patients with any type of health condition who underwent laparoscopic surgery using the AIRSEAL® insufflation system or a standard CO2 insufflator. Ten studies (four randomized clinical trials/six non-randomized clinical trials), that enrolled 1394 participants in total who underwent urology, gynaecology or abdominal surgeries, were included. Total complication rates were similar between groups. Only three studies evaluated the impact of the insufflation system on post-operative pain, and showed inconsistent benefit of AIRSEAL® (significant decrease in pain in two studies, no difference in one). The same was observed in the two sole studies in which pain killers consumption was measured (significant decrease in morphine consumption 24h after surgery in one study, no difference in the other). Operative duration was significantly shorter with AIRSEAL® in three studies. For both post-operative room and total length of stay, there was no difference between groups. No studies reported economic outcomes. Current literature supports the feasibility of the AIRSEAL® system during laparoscopic surgery but more studies are required to establish the added clinical benefit and to explore the preferences of physicians and patients.

Pneumoperitoneum in laparoscopic surgery: Comparison of the effect on gastric and intestinal motility in pediatric and adult rats

Amac: Literaturde, pnomoperitonun eriskinlere kiyasla cocuklarda mide ve bagirsak hareketliligini nasil etkiledigi konusunda sinirli veri bulunmaktadir. Bu deneysel calismanin amaci, cocuklarda ve yetiskin sicanlarda pnomoperitonun gastrik ve ince bagirsak hareketliligi uzerindeki etkilerini olcmek ve karsilastirmaktir. Yontemler: Calisma 4 grupta yapildi. Grup 1'de (n=8) ve 2'sinde (n=7) pediatrik yasta, grup 3'te (n=10) ve 4'unde (n=10) yetiskin yasta sicanlar vardi. Grup 1 ve 3'te pnomoperiton uygulandi. Grup 2 ve 4'te laparotomi yapildi. Islem suresi tum gruplarda 90 dakika idi. CO2 insuflasyonu (Thermoflator, Karl-Storz, Almanya) 5 mHg-0,5 ml/dk basincta uygulandi. Postoperatif mide ve bagirsak motilite calismalari tum gruplarda yapildi. Asetilkolin ve KCl'ye (10-8 ila 10-3 mM'lik bir doz araliginda) kontraktil cevaplar kaydedildi (Izometrik Donusturucu, Biopac, ABD). Verilerin analizinde Veri Toplama Analiz Sistemi (MP100 Biopac, ABD) kullanilmistir. Bulgular: En dusuk kasilma cevabi, hem mide hem de bagirsak icin grup 1'de elde edildi. Pediatrik gruplarin potasyum klorid ve asetilkoline verdigi yanitlar yetiskin gruplardan daha dusuktu, ancak 4 grup arasinda anlamli fark yoktu (P>0,05). Sonuc: Bu calisma, pediatrik ve eriskin yas gruplari icin benzer bir ortamda, pnomoperitonun cocuklarda mide ve ince bagirsak hareketliligi uzerinde onemli bir olumsuz etki yapmadigini ortaya koyabilir. Gelecekteki calismalar, farkli yaslarda, agirliklarda, anestezi tiplerinde, karin ici basinc ve surelerinde pnomoperitonun mide ve bagirsak hareketliligi uzerindeki etkilerini arastirmayi amaclamalidir.

A comparative study of open versus closed method of establishment of pneumoperitoneum in laparoscopic surgery

Background: Laparoscopy has overtaken open surgery as the choice of procedure wherever feasible. More than 50% of complications in laparoscopy occur during creation of pneumoperitoneum. In this study, we are comparing open or Hasson's method and closed or vress method of creation of pneumoperitoneum.Methods: This is a prospective comparative parallel randomised control trial conducted at the Department of Surgery, Baroda Medical College and SSG Hospital from November, 2017 to November, 2018. We divided the patients (n=100) into two groups i.e., open method (group O) (n1=50) and closed method (group C) (n2=50) groups using the envelope method of randomisation. We compared the two techniques in terms of time required to complete the procedures and complications (major and minor) associated with creation of pneumoperitoneum.Results: All the patients that participated in this study belonged to the age group of 10-69 years out of which majority were 15-50 years old. In our study, the mean time required to create pneumoperitoneum by closed method (group C) was 9.3 seconds while by open method (group O), it was 7.84 seconds with p value &lt;0.001. There were 15 cases of gas leak from the port side, all recorded in the open method of establishment of pneumoperitoneum.Conclusions: Even though the open method takes less time to create pneumoperitoneum, both methods are similar in terms of time taken to complete the operation and major and minor complications because there was no statistically significant difference in the frequency of these parameters between the two techniques.

Comparative Study of Veress Needle and Visiport in Creating Pneumoperitoneum in Laparoscopic Surgery

Comparative Study of Veress Needle and Visiport in Creating Pneumoperitoneum in Laparoscopic Surgery

Randomised study to compare direct trocar insertion and Veress needle technique for creation of pneumoperitoneum in laparoscopic surgery

Introduction Laparoscopy today is a common procedure in many surgical specialities, majority of complications arising from laparoscopy are often related to initial entry into the abdomen. Access related major complications include injury to viscera and vasculature while minor complications also occur such as postoperative wound infection, subcutaneous emphysema, and extraperitoneal insufflation. There is no clear consensus as to the optimal method of laparoscopic entry into the peritoneal cavity. Objectives We aimed to compare safety and efficacy of Direct trocar insertion versus Veress needle technique in laparoscopic surgery. Material and methods This prospective study was conducted on hundered patients who underwent laparoscopic surgery in our surgical unit at University of health Sciences from Jan 2015 to Oct 2016. Cases were randomly divided by sealed envelope method into two groups- 50 cases of direct trocar insertion and 50 cases of veress needle technique. Intraoperative access related parameters were recorded and compared. Data were analyzed with Student’s t and chi-squared tests. P value of

What is the proper ventilation strategy during laparoscopic surgery?

The main stream of intraabdominal surgery has changed from laparotomy to laparoscopy, but anesthetic care for laparoscopic surgery is challenging for clinicians, because pneumoperitoneum might aggravate respiratory mechanics and arterial oxygenation. The authors reviewed the literature regarding ventilation strategies that reduce deleterious pulmonary physiologic changes during pneumoperitoneum for laparoscopic surgery under general anesthesia and make appropriate recommendations.

Neutrophil Gelatinase-Associated Lipocalin Levels During Pneumoperitoneum.

Background and Objectives:A temporary deterioration in renal function during pneumoperitoneum has been reported, but the extent is not known. A new marker for the early detection of renal injury, neutrophil gelatinase-associated lipocalin (NGAL), has been shown to increase in various conditions that affect renal function. This study was conducted to explore detrimental effects of pneumoperitoneum in laparoscopic surgery on renal function by studying levels of urinary NGAL (uNGAL).Methods:Thirty-two women scheduled to undergo laparoscopic surgery in a gynecology clinic were recruited. NGAL was measured in urine collected at the beginning (0 h) and at 2 and 24 hours after the initiation of surgery. Hemodynamic parameters were analyzed immediately after intubation and before desufflation.Results:Levels of uNGAL increased from 5.45 ng/mL at 0 hours to 6.35 ng/mL at 2 hours and to 6.05 ng/mL at 24 h; however, there was no significant change in uNGAL levels at the collection time points. Intraoperative oliguria was observed in all cases, and the severity increased with the duration of surgery. uNGAL levels did not correlate with the duration of surgery or pneumoperitoneum.Conclusion:In patients with normal renal functions, pneumoperitoneum results in transient oliguria without any early renal damage, as indicated by nonsignificant changes in uNGAL levels.

Effects of intraoperative protective lung ventilation on postoperative pulmonary complications in patients with laparoscopic surgery: prospective, randomized and controlled trial.

Respiratory functions are usually impaired during pneumoperitoneum for laparoscopic surgery. This randomized, controlled and single-blinded study was performed to evaluate whether intraoperative protective lung ventilation influences postoperative pulmonary complications after laparoscopic hepatobiliary surgery. Sixty-two patients were randomized to receive either conventional ventilation with alveolar recruitment maneuver (tidal volume of 10ml/kg with inspiratory pressure of 40 cmH2O for 30s after the end of pneumoperitoneum, group R), or protective lung ventilation (low tidal volume of 6ml/kg with positive end-expiratory pressure [PEEP] of 5 cmH2O, group P). Induction and maintenance of anesthesia were done with balanced anesthesia. Respiratory complications such as atelectasis, pneumonia or desaturation were observed postoperatively. The length of hospital stay, arterial blood gas analysis, peak inspiratory pressure and hemodynamic variables were also recorded. Results are presented as mean±SD or number of patients (%). Postoperative pulmonary complications (P=0.023) and desaturation below 90% (P=0.016) occurred less frequently in group P than in group R. Eight patients of group R and 3 patients of group P showed atelectasis. Pneumonia was diagnosed in 1 patient of group R. No differences were observed in the length of hospital stay, arterial blood gas analysis (pH, PaO2, PaCO2 and PAO2) and hemodynamic variables except PAO2, AaDO2 and peak inspiratory pressure between the two groups. Protective lung ventilation (low tidal volume with PEEP) during pneumoperitoneum was associated with less incidences of pulmonary complications than conventional ventilation with alveolar recruitment maneuver after laparoscopic hepatobiliary surgery.

The effect of pneumoperitoneum on intravascular fibrinolytic activity in rats.

Venous stasis during pneumoperitoneum in laparoscopic surgery is closely related to fibrin synthesis and deposition. The etiologic factors underlying fibrinolysis or hypercoagulability are not clearly defined. This study aimed to determine the effects of pneumoperitoneum time and pressure on coagulation cascade and the fibrinolytic pathway. After the pneumoperitoneum model was established in rats, PAI-1, tPA, TAFI, D-dimer, and fibrinogen activities were evaluated in different time periods under different pressures in groups including 6 rats. Group 1 did not undergo any procedure. Group 2 received 8 mmHg of pressure for 30 min, Group III 8 mmHg for 60 min, Group IV 12 mmHg for 30 min, and Group V 12 mmHg for 60 min. D-dimer levels had a tendency to decrease with increasing intraabdominal pressures. In both low and high pressure groups, fibrinogen had a tendency to increase with exposure time. There was no statistically significant difference among the study groups in terms of fibrinogen, D-dimer, and PAI-1. The levels of TAFI were significantly decreased with increasing pressure regardless of the exposure time. Pneumoperitoneum of the coagulation system can be changed by duration of time and pressure.

Comparison of Open and Closed Entry Techniques for Creation of Pneumoperitoneum in Laparoscopic Surgery in Terms of Time Consumption, Entry-related Complicatons and Failure of Technique

Comparison of Open and Closed Entry Techniques for Creation of Pneumoperitoneum in Laparoscopic Surgery in Terms of Time Consumption, Entry-related Complicatons and Failure of Technique

Comparison of Open and Closed Entry Techniques for Creation of Pneumoperitoneum in Laparoscopic Surgery in Terms of Time Consumption, Entry-related Complicatons and Failure of Technique

Comparison of Open and Closed Entry Techniques for Creation of Pneumoperitoneum in Laparoscopic Surgery in Terms of Time Consumption, Entry-related Complicatons and Failure of Technique