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Nose Y, Kato M, Aoyagi S, Akeo K, Yamashita K, Saito T, Tanaka K, Yamamoto K, Makino T, Takahashi T, Kurokawa Y, Eguchi H, Doki Y, Nakajima K. Use of current automatic smoke evacuation system in flexible gastrointestinal endoscopy: Its feasibility and potential usefulness. DEN OPEN 2024; 4:e367. [PMID: 38605997 PMCID: PMC11007223 DOI: 10.1002/deo2.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
Objectives Flexible endoscopy does not have a system that can automatically evacuate surgical smoke generated in the gastrointestinal lumen. We aimed to investigate the feasibility and potential usefulness of automatic smoke evacuation systems in flexible endoscopy. Methods [Bench] After surgical smoke generated in the stomach was evacuated by the evacuator, the degree of residual smoke and gastric luminal collapse were evaluated to optimize the evacuator settings. [Animal] Insufflation, suction, and total operation time to complete the protocol of 10 cauterizations of the gastric mucosa were measured in three groups: "manual suction only," "manual suction with automatic evacuation (50% force)," and "manual suction with automatic evacuation (70% force)." The stability of endoscopic visualization and operability was evaluated by 10 endoscopists blinded to those suction settings, and the number of manual suctions, insufflations, and total operation time were measured. Results [Bench] The degree of residual smoke and gastric luminal collapse were inversely correlated. [Animal] When the automatic evacuator was partially used, there was no difference in the insufflation time, but the suction time (vs 50%; p = 0.011, vs. 70%; p = 0.011) and total operation time (vs. 50%; p = 0.012, vs. 70%; p = 0.036) were significantly reduced compared to manual operation only. Furthermore, manual suction with automatic evacuation (50% force) significantly improved the stability of endoscopic visualization and operability compared to manual operation only (p = 0.041, p = 0.0085). Conclusions The automatic smoke evacuation in flexible gastrointestinal endoscopy was potentially feasible and useful by improving the device setting.
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Affiliation(s)
- Yohei Nose
- Department of Next Generation Endoscopic Intervention (Project ENGINE)Graduate School of Medicine, Osaka UniversityOsakaJapan
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Motohiko Kato
- Center for Diagnostic and Therapeutic EndoscopyKeio University School of MedicineTokyoJapan
| | | | | | - Kotaro Yamashita
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Takuro Saito
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Koji Tanaka
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Tomoki Makino
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Yukinori Kurokawa
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Hidetoshi Eguchi
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
| | - Kiyokazu Nakajima
- Department of Next Generation Endoscopic Intervention (Project ENGINE)Graduate School of Medicine, Osaka UniversityOsakaJapan
- Department of Gastroenterological SurgeryGraduate School of Medicine Osaka UniversityOsakaJapan
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Wei M, Yang W, Zhou J, Ye Z, Ji Z, Dong J, Xu W. Comparison of AirSeal versus conventional insufflation system for retroperitoneal robot-assisted laparoscopic partial nephrectomy: a randomized controlled trial. World J Urol 2024; 42:90. [PMID: 38381369 PMCID: PMC10881696 DOI: 10.1007/s00345-024-04819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024] Open
Abstract
PURPOSE AirSeal is a valve-less trocar insufflation system which is widely used in robotic urologic surgeries. More evidence is needed concerning the application and cost of AirSeal in retroperitoneal robot-assisted laparoscopic partial nephrectomy. METHODS We conducted a randomized controlled trial enrolling 62 patients who underwent retroperitoneal robot-assisted laparoscopic partial nephrectomy from February 2022 to February 2023 in the Peking Union Medical College Hospital. Patients were randomly assigned into AirSeal insufflation (AIS) group and conventional insufflation (CIS) group. The primary outcome was the rate of subcutaneous emphysema (SCE). RESULTS The SCE rate in the AIS group (12.9%) was significantly lower than that in the CIS group (35.5%) (P = 0.038). Lower maximum end-tidal carbon dioxide (CO2) (41 vs 45 mmHg, P = 0.011), PaCO2 at the end of the operation (40 vs 45 mmHg, P < 0.001), maximum tidal volume (512 vs 570 ml, P = 0.003), frequency of lens cleaning (3 vs 5, P < 0.001), pain score at 8 h (3 vs 4, P = 0.025), 12 h (2 vs 3, P = 0.029) postoperatively and at time of discharge (1 vs 2, P = 0.002) were observed in the AIS group, despite a higher hospitalization cost (68,197 vs 64658RMB, P < 0.001). Logistic regression analysis identified insufflation approach was the only influencing factor for the occurrence of SCE events. CONCLUSION AirSeal insufflation system exhibited similar efficacy and improved safety for retroperitoneal robot-assisted laparoscopic partial nephrectomy than conventional insufflation system, despite an affordable increase of hospitalization costs.
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Affiliation(s)
- Mengchao Wei
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, 100000, China
| | - Wenjie Yang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, 100000, China
| | - Jingmin Zhou
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, 100000, China
| | - Zixing Ye
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, 100000, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, 100000, China
| | - Jie Dong
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, 100000, China.
| | - Weifeng Xu
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, 100000, China
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Chae HC, Kim BJ, Choi YS, Suh SW, Lee SE. Efficacy of Filter Trocar for Clear Visualization during Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Trial. J Pers Med 2024; 14:204. [PMID: 38392637 PMCID: PMC10890709 DOI: 10.3390/jpm14020204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024] Open
Abstract
Filter trocar designed to eliminate harmful smoke is also regarded as effective for improving surgical visualization. The aim of this study is to evaluate the efficacy of filter trocar in maintaining clear operative view. From 2019 to 2020, 100 patients underwent laparoscopic cholecystectomy and they were randomized to either the control or filter group. The primary end point was a laparoscopic operative view score (1, clear; 2, slightly blurry; 3, completely blurry) during gallbladder dissection from the liver bed when dissection was started (LV1), when dissection was half completed (LV2) and when dissection was completed (LV3). Between the control and filter groups, there were no significant differences in mean LV1 (1.44 vs. 1.40, p = 0.234) and LV3 (1.86 vs. 2.01, p = 0.880). There was no significant difference in the mean duration of suction after dissection (3.82 s vs. 3.67 s, p = 0.097) and the mean number of laparoscope removals from inside to outside the body to clean during gallbladder dissection from the liver bed (0.55 vs. 0.22, p = 0.963) or the mean amount of time required to dissect the gallbladder from the liver bed (221.58 s vs. 177.09 s, p = 0.253). The study demonstrated that filter trocar is not as effective as expected in the maintenance of clear operative view. Further study is needed to develop devices to improve clear surgical visualization.
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Affiliation(s)
- Ho-Chang Chae
- Samsung Medical Center, Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Beom-Jin Kim
- Department of Surgery, Seoul Song-do Hospital, Seoul 04597, Republic of Korea
| | - Yoo Shin Choi
- Department of Surgery, Chung-Ang University College of Medicine, Seoul 06974, Republic of Korea
| | - Suk-Won Suh
- Department of Surgery, Chung-Ang University College of Medicine, Seoul 06974, Republic of Korea
| | - Seung Eun Lee
- Department of Surgery, Chung-Ang University College of Medicine, Seoul 06974, Republic of Korea
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Ayoub CH, Armache AK, El-Asmar JM, El-Achkar A, Abdulfattah S, Bidikian N, Abou Chawareb E, Hoyek E, El-Hajj A. The impact of AirSeal ® on complications and pain management during robotic-assisted radical prostatectomy: a single-tertiary center study. World J Urol 2023; 41:2685-2692. [PMID: 37704868 DOI: 10.1007/s00345-023-04573-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE We aimed to compare perioperative outcomes, post-operative complications, and opioid use between AirSeal® and non-AirSeal® robotic-assisted radical prostatectomy (RARP). METHODS We retrospectively collected data on 326 patients who underwent elective RARP at our institution either with or without AirSeal®. The first 60 cases were excluded accounting for the institutions' learning curve of RARP. Patient demographics, oncologic, pathologic, and surgical characteristics between AirSeal® and non-AirSeal® cases were compared. Furthermore, outcomes of interest including operative time, length of stay, morbidity, and opioid use for pain management were compared between the two groups. Univariate linear and logistic regression models were developed. RESULTS The AirSeal® group consisted of 125 (38.3%) patients while the non-AirSeal® group consisted of 201 (61.7%) patients. No statistically significant difference was seen in terms of patient demographics, oncologic characteristics, surgical characteristics, and pathologic characteristics between the two groups. In addition, univariate linear regression showed that RARP with AirSeal® displayed shorter operative times by 12.3 min and a shorter length of hospital stay by 0.5 days compared to the non-AirSeal® group (p < 0.001). Furthermore, the AirSeal® group witnessed lower odds of Clavien-Dindo (CVD) Class > 2 complications (OR = 0.102) and a lower need for opioid use (OR = 0.49) compared to the non-AirSeal® group (p < 0.022). CONCLUSION RARP using AirSeal® is associated with shorter operative times, shorter length of hospital stays, lower odds of CVD > 2 complications, and lower odds of opioid use with respect to non-AirSeal® RARP. The efficacy and cost effectiveness of using the AirSeal® system during RARP should be further studied and evaluated by clinical trials.
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Affiliation(s)
- Christian Habib Ayoub
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon
| | - Alexandre K Armache
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon
| | - Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon
| | - Adnan El-Achkar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon
| | - Suhaib Abdulfattah
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Nayda Bidikian
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Elia Abou Chawareb
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon
| | - Elio Hoyek
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon
| | - Albert El-Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon.
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5
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Margue G, Bigot P, Ingels A, Roupret M, Waeckel T, Long JA, Pignot G, Bensalah K, Lang H, Olivier J, Bruyere F, Durand M, Beauval JB, Mallet R, Parier B, De La Taille A, Bernhard JC. Clinical trial protocol for P-NeLoP: a randomized controlled trial comparing the feasibility and outcomes of robot-assisted partial nephrectomy with low insufflation pressure using AirSeal versus standard insufflation pressure (UroCCR no. 85 study). Trials 2023; 24:545. [PMID: 37596613 PMCID: PMC10439590 DOI: 10.1186/s13063-023-07533-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/21/2023] [Indexed: 08/20/2023] Open
Abstract
Robot-assisted partial nephrectomy (RAPN) is the standard of care for small, localized kidney tumors. This surgery is conducted within a short hospital stay and can even be performed as outpatient surgery in selected patients. In order to allow early rehabilitation of patients, an optimal control of postoperative pain is necessary. High-pressure pneumoperitoneum during surgery seems to be the source of significant pain during the first hours postoperatively. Our study is a prospective, randomized, multicenter, controlled study which aims to compare post-operative pain at 24 h between patients undergoing RAPN at low insufflation pressure (7 mmHg) and those operated on at standard pressure (12 mmHg) using the AirSeal system.This trial is registered in the US National Library of Medicine Trial Registry (NCT number: NCT05404685).
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Affiliation(s)
- Gaelle Margue
- Urology Department, Bordeaux University Hospital, Bordeaux, France.
| | - Pierre Bigot
- Urology Department, Angers University Hospital, Angers, France
| | - Alexandre Ingels
- Urology Department, Henri Mondor University Hospital, APHP, Paris, France
| | - Morgan Roupret
- Urology Department, Pitié-Saplétrière Hospital, APHP, Paris, France
| | | | | | | | - Karim Bensalah
- Urology Department, Rennes University Hospital, Rennes, France
| | - Hervé Lang
- Urology Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Franck Bruyere
- Urology Department, Tours University Hospital, Tours, France
| | | | | | - Richard Mallet
- Urology Department, Polyclinique Francheville, Perigueux, France
| | - Bastien Parier
- Urology Department, Kremlin Bicetre, APHP, Paris, France
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Forte F, Tripodi D, Pironi D, Corongiu E, Gagliardi F, Frisenda M, Gallo G, Quarantiello A, Di Lorenzo G, Cavaleri Y, Salciccia S, Lori E, Sorrenti S. Comparison of laparoscopic partial nephrectomy performed with AirSeal® system vs. standard insufflator: results from a referral center. Front Surg 2023; 10:1220332. [PMID: 37440928 PMCID: PMC10335758 DOI: 10.3389/fsurg.2023.1220332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
Objective To compare perioperative and oncologic surgical outcomes during laparoscopic partial nephrectomy (LPN) performed by standard carbon dioxide insufflation, with those from surgeries in which the AirSeal® intelligent insufflation system was used for renal tumors. Materials and methods A total of 27 patients with renal tumor were identified, 14 underwent LPN with AirSeal® (group A) and 13 LPN with standard insufflator (group B), respectively. Demographic baseline characteristics were similar in the two groups. Results The size of the tumor was largest in group B (29.64 vs. 32.1 mm). The mean operative time was shorter in the AirSeal® group [group A: mean 109.0 min, median 107.5 min, interquartile range (IQR) 85; group B: mean 121.0 min, median 120.0 min, IQR 50.0]. Positive margin rates were absent in the two groups. Estimated blood loss presented a difference in the perioperative period (group A: mean 1.5 g/dL, median 1.45 g/dL; group B: mean 2.15 g/dL, median 2.2 g/dL). Time to ischemia was found to be shorter in group A with a median of 18 min compared to a median of 20 min in group B. No subcutaneous emphysema, pneumothorax, and pneumomediastinum cases occurred in either group. A postoperative complication developed in one patient requiring superselective embolization. Conclusion In selected patients, our preliminary surgical experience has shown that the LPN procedure performed with the aid of the AirSeal® intelligent insufflation system can be used to treat even medium-/high-complexity kidney lesions, with a reduction in operating times, lower rates of complications, and perioperative blood loss. Clinical trial registration AirSealV1.
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Affiliation(s)
- Flavio Forte
- Department of Urology, M.G. Vannini Hospital, Rome, Italy
| | | | - Daniele Pironi
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | | | | | - Marco Frisenda
- Department of Urology, M.G. Vannini Hospital, Rome, Italy
| | - Gaetano Gallo
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Antonia Quarantiello
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Di Lorenzo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Yuri Cavaleri
- Department of Urology, San Giovanni Battista Hospital, Foligno, Italy
| | - Stefano Salciccia
- Department of Maternal-Infant and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Eleonora Lori
- Department of Surgery, Sapienza University of Rome, Rome, Italy
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Razdan S, Ucpinar B, Okhawere KE, Badani KK. The Role of AirSeal in Robotic Urologic Surgery: A Systematic Review. J Laparoendosc Adv Surg Tech A 2023; 33:21-31. [PMID: 35671523 DOI: 10.1089/lap.2022.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction: The adoption of a valveless trocar system in robotic surgery has allowed for stable pneumoperitoneum and constant smoke evacuation. The reported benefits of this system are improved visualization, lower abdominal pressures resulting in a decrease in cardiopulmonary complications, ileus, and postoperative pain. We endeavored to perform a systematic review of the available literature on the clinical and systems-based outcomes of AirSeal™ during robotic urologic surgery. Materials and Methods: We performed this review according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Our population of interest was any patient undergoing robotic urologic surgery. Our outcomes of interest were (1) clinical effectiveness, (2) safety parameters, and (3) health system outcomes. Results: Of 83 records identified and screened at title/abstract level, 17 were examined for full-text, of which 10 studies enrolling a total of 1765 patients (cohorts ranging in size from 11 to 642 patients) were ultimately used for review. AirSeal resulted in improved respiratory parameters, specifically lower inspiratory plateau pressure, lower minute volume, lower CO2 elimination rate, low end-tidal CO2, and higher static compliance. Two studies described decreased complication rates with low pneumoperitoneum. There were mixed results regarding AirSeal effect on operative time. Conclusion: Valveless trocar technology using the AirSeal system is a valuable adjunct to current robotic urologic surgery. The established benefits include improved cardiopulmonary parameters, particularly within the steep trendelenburg position that is common in pelvic surgery. Further studies are necessary to elucidate the effects on safety and hospital system-wide outcomes.
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Affiliation(s)
- Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Burak Ucpinar
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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8
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Delecourt C, Tourette C, Crochet P, Pivano A, Hamouda I, Agostini A. Benefits of AirSeal® System in Laparoscopic Hysterectomy for Benign Condition: A Randomized Controlled Trial. J Minim Invasive Gynecol 2022; 29:1003-1010. [DOI: 10.1016/j.jmig.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
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Claroni C, Morettini L, Tola G, Covotta M, Forastiere E, Torregiani G. Valveless Trocar Versus Standard Pneumoperitoneum Insufflation System in Minimally Invasive Surgery: Impact on Postoperative Pain. A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2022; 32:978-986. [PMID: 35404130 DOI: 10.1089/lap.2022.0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Claudia Claroni
- Department of Anesthesiology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Lucio Morettini
- Research Institute on Sustainable Economic Growth of the National Research Council of Italy, Rome, Italy
| | - Gabriele Tola
- Department of Anesthesiology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Covotta
- Department of Anesthesiology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Ester Forastiere
- Department of Anesthesiology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Torregiani
- Department of Anesthesiology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
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Yuvaraja TB, Dev P, Waigankar S, Ranade S, Pednekar A, Agarwal V, Khandekar A, Badlani N, Asari A. Safety of uro-oncology practice and robot-assisted surgery during the peak of COVID-19 pandemic: A report from India. J Cancer Res Ther 2022; 18:1629-1634. [DOI: 10.4103/jcrt.jcrt_1006_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Yano F, Kira S, Takahashi N, Sawada N, Nakagomi H, Ihara T, Takeda M, Mitsui T. Risk Factors for Atelectasis or Pneumomediastinum After Robot-Assisted Partial Nephrectomy. Cureus 2021; 13:e20383. [PMID: 35036214 PMCID: PMC8752410 DOI: 10.7759/cureus.20383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 11/05/2022] Open
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Socarrás MR, Elbers JR, Rivas JG, Autran AM, Esperto F, Tortolero L, Carrion DM, Sancha FG. Retroperitoneal Robot-Assisted Partial Nephrectomy (rRAPN): Surgical Technique and Review. Curr Urol Rep 2021; 22:33. [PMID: 34014412 DOI: 10.1007/s11934-021-01051-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW We aim to offer a description of the surgical technique and to review the current state retroperitoneal robot-assisted partial nephrectomy (rRAPN). RECENT FINDINGS Partial nephrectomy is the standard treatment for localized kidney tumours. rRAPN is especially useful for kidney tumours of posterior location. It offers advantages such as direct access to the renal artery and no need for bowel mobilization. The disadvantages are the small working space and the less familiar anatomical landmarks. It is a reproducible technique that achieves similar oncological and functional results to the more traditional transperitoneal route (tRAPN). High-quality randomized studies are needed to ascertain the role of new technologies as modern high-flow insufflation systems, intracavitary ultrasound, 3D planning, and augmented reality (AR), in the performance of this operation. rRAPN is especially useful for kidney tumours of posterior location. Robotic surgeons ideally should become familiar with both approaches, transperitoneal or retroperitoneal.
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Affiliation(s)
- Moises Rodríguez Socarrás
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO, Madrid, Spain. .,ICUA, Clínica CEMTRO II, Ventisquero de la Condesa 48, 3ª planta, 28034, Madrid, Spain.
| | | | - Juan Gómez Rivas
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO, Madrid, Spain
| | - Ana Maria Autran
- Oficina de Investigacion CAU (Confederacion Americana de Urologia), Madrid, Spain
| | | | | | - Diego M Carrion
- Instituto de Cirugía Urológica Avanzada (ICUA) - Clínica CEMTRO, Madrid, Spain
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da Costa KM, Saxena AK. Coronavirus disease 2019 pandemic and identifying insufflators with desufflation mode and surgical smoke evacuators for safe CO 2 removal. Asian J Endosc Surg 2021; 14:165-169. [PMID: 32715659 DOI: 10.1111/ases.12834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/09/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Given the propensity of severe acute respiratory syndrome coronavirus 2 to spread, it is imperative that those continuing to perform surgery take precautions to limit the potential generation of contaminated aerosols in smoke from energy-based instruments. The aim of this study was to report current data regarding insufflators with desufflation mode and similar options to safely remove CO2 in minimal access surgery. METHODS A non-systematic review of the scientific literature was conducted using the PubMed database, and the main companies that provide surgical devices were contacted for information. RESULTS Most commercially available smoke evacuators use a combination of suction and mechanical filtering. There are also electrostatic precipitators that charge surgical smoke and retain the particles via electrostatic attraction. The search identified three insufflators with desufflation mode, four modular smoke evacuators using mechanical filtration, and only one device using electrostatic precipitation. However, none of these devices has been tested with viruses. CONCLUSION This review identified commercially available equipment that employs mechanical filtering and electrostatic attraction principles that can be used for pneumoperitoneum evacuation during the present coronavirus disease 2019 pandemic. This pandemic should assist in raising awareness regarding protection measures and the risk of occupational exposure in surgery.
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Affiliation(s)
- Karina M da Costa
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK.,Division of Pediatric Surgery, Department of Pediatrics, Regional University Hospital of Maringá, State University of Maringá, Maringá, Brazil
| | - Amulya K Saxena
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK
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Comparison of the Safety and Efficacy of Valveless and Standard Insufflation During Robotic Partial Nephrectomy: A Prospective, Randomized, Multi-institutional Trial. Urology 2021; 153:185-191. [PMID: 33577899 DOI: 10.1016/j.urology.2021.01.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To use a randomized, prospective, multi-institutional study to compare the safety and efficacy of conventional insufflation (CIS) and valveless insufflation (AirSeal Insufflation - AIS) at the conventional pressure of 15 mm Hg in robot-assisted partial nephrectomy - a surgery where AIS has gained popularity for maintaining visualization despite suction. This study was also powered to evaluate the effect of decreasing pneumoperitoneum by 20% in the valveless system. MATERIALS AND METHODS Three high-volume institutions randomized subjects into CIS 15, AIS 15, and AIS 12 mm Hg cohorts. Endpoints included rates of subcutaneous emphysema (SCE), pneumothorax (PTX), pneumomediastinum (PMS), intraoperative end-tidal carbon dioxide (ET CO2), and peak airway pressure (PAP), as well as hospital stay, post-operative pain, and complications. Given the substantial proportion of retroperitoneal surgery, a secondary analysis evaluated the effect of surgical approach. RESULTS Two hundred and two patients were accrued. SCE was decreased in the AIS 12 mm Hg group (p=0.003). PTX and PMS rates were not statistically significantly different across the 3 insufflation groups. Higher rates of SCE and PMS, although not PTX, were noted in all retroperitoneal surgery groups - with lower SCE rates for AIS 12 mm Hg regardless of surgical approach. CONCLUSION AIS is often preferred for complex procedures including retroperitoneal and transperitoneal robotic-assisted partial nephrectomy, for its maintenance of pneumoperitoneum despite continuous suction necessary for visualization. This study shows that AIS is safe when compared to CIS at 15 mm Hg, and shows improvement in outcomes when pneumoperitoneum pressure is reduced by 20% to 12 mmHg.
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15
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Abaza R, Martinez O, Murphy C. Randomized Controlled Comparison of Valveless Trocar (AirSeal) vs Standard Insufflator with Ultralow Pneuomoperitoneum During Robotic Prostatectomy. J Endourol 2021; 35:1020-1024. [PMID: 33349135 DOI: 10.1089/end.2020.1025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To compare valveless insufflation (AirSeal®) with a conventional insufflation system (CIS) during robotic prostatectomy (RP) and the ability to use ultralow pneumoperitoneum at 6 mm Hg with each system as well as comparison of physiologic outcomes and pain scores. Patients and Methods: We conducted a prospective study of 100 patients randomized to AirSeal or CIS during RP. The frequency of need for increasing pneumoperitoneum was assessed as well as arterial blood gases, respiratory/hemodynamic parameters, pain scores, and analgesic requirements. Quality of smoke evacuation and scope cleaning frequency were also measured. Results: All procedures were completed at 6 mm Hg without needing to increase pressures with either insufflator. There were no statistically significant differences in partial pressure of carbon dioxide (PaCO2), partial pressure of oxygen (PaO2), HCO3, pH, carbon dioxide (CO2) elimination, or end-tidal carbon dioxide pressure (EtCO2) between groups. The AirSeal group had a lower maximum peritoneal pressure (7.9 vs 9.9 mm Hg, p < 0.001) but without differences in pain scores or analgesics. Surgeon-assessed smoke evacuation was poorer using CIS with more laparoscope cleanings in nonobese patients than with AirSeal (2.1 vs 3.0, p = 0.026). Conclusion: Valveless-trocar insufflation provided more stable pressure but without benefits in physiologic or pain parameters. Previously identified benefits may have been negated by being able to complete all procedures at ultralow pressure with either insufflator, although an expert bedside assistant moderating suction may have contributed to feasibility of maintaining low pressure with CIS. A randomized trial of 6 vs 15 mm Hg is currently underway. The ClinicalTrials.gov Identifier: NCT02114164.
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Affiliation(s)
- Ronney Abaza
- Department of Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, Ohio, USA.,Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio, USA
| | - Oscar Martinez
- Department of Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, Ohio, USA
| | - Christopher Murphy
- Department of Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, Ohio, USA
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16
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Tuna MB, Doganca T, Tufek I, Argun OB, Keskin S, Obek C, Kural AR. Off-Clamp Robot-Assisted Partial Nephrectomy: Is There Something More to Achieve Optimal Trifecta Outcomes? J Endourol 2020; 35:1153-1157. [PMID: 33198502 DOI: 10.1089/end.2020.0747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: To report trifecta outcomes of our "off-clamp" partial nephrectomy (PN) patients operated without main renal artery and/or any selective/superselective clamping. Materials and Methods: Between April 2008 and March 2020, 52 patients received "off-clamp" robot-assisted partial nephrectomy. Postoperative sixth month estimated glomerular filtration rate (eGFR) and eGFR decrease were considered for renal function evaluation. Patients with negative surgical margins, <15% postoperative eGFR decrease and absence of grade ≥2 Clavien-Dindo complications were reported to achieve trifecta outcomes. Results: Mean age and body mass index of the patients were 57.51 ± 12.99 years and 27.23 ± 4.35 kg/m2, respectively. Mean preoperative hematocrit, serum creatinine, and eGFR were 42.01 ± 3.86%, 0.92 ± 0.28 mg/dL, and 85.26 ± 21.27 mL/min/1.73 m2, respectively. Mean tumor size was 30.32 ± 13.64 mm. Mean PADUA and RENAL scores were 7.63 ± 1.46 and 6.21 ± 1.63, respectively. One patient had focal surgical margin positivity. Mean console time and estimated blood loss was 82.11 ± 38.51 minutes and 280.76 ± 278.98 mL, respectively. Complications were observed in two (4%) patients (one Clavien I, one Clavien IIIB). At postoperative sixth month, serum creatinine and eGFR were 0.95 ± 0.32 mg/dL and 83.65 ± 22.44 mL/min/1.73 m2, respectively. Eventually seven patients had ≥15% postoperative eGFR decrease, one patient had grade ≥2 complication and one patient had positive surgical margin. Forty-three (83%) patients fulfilled trifecta outcomes. Conclusion: Off-clamp PN is important for optimal renal function preservation. Patient selection and additional operative measures along with experience in robotic procedure can contribute achievement of optimal trifecta outcomes.
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Affiliation(s)
| | - Tunkut Doganca
- Department of Urology, Acibadem Taksim Hospital, Istanbul, Turkey
| | - Ilter Tufek
- Department of Urology, Acibadem Mehmet Ali Aydinlar University Medical Faculty, Istanbul, Turkey
| | - Omer Burak Argun
- Department of Urology, Acibadem Mehmet Ali Aydinlar University Medical Faculty, Istanbul, Turkey
| | - Selcuk Keskin
- Department of Urology, Acibadem Mehmet Ali Aydinlar University Medical Faculty, Istanbul, Turkey
| | - Can Obek
- Department of Urology, Acibadem Mehmet Ali Aydinlar University Medical Faculty, Istanbul, Turkey
| | - Ali Riza Kural
- Department of Urology, Acibadem Mehmet Ali Aydinlar University Medical Faculty, Istanbul, Turkey
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17
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Balayssac D, Selvy M, Martelin A, Giroudon C, Cabelguenne D, Armoiry X. Clinical and Organizational Impact of the AIRSEAL ® Insufflation System During Laparoscopic Surgery: A Systematic Review. World J Surg 2020; 45:705-718. [PMID: 33258023 DOI: 10.1007/s00268-020-05869-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 01/01/2023]
Abstract
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 24 h 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.
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Affiliation(s)
- David Balayssac
- INSERM, U1107, NEURO-DOL, Université Clermont Auvergne, 63000, Clermont-Ferrand, France. .,Délégation à la Recheche Clinique et à l'Innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.
| | - Marie Selvy
- INSERM, U1107, NEURO-DOL, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.,Service de Chirurgie Digestive, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Anthony Martelin
- Service Pharmacie, Unité des dispositifs médicaux, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69000, Lyon, France
| | - Caroline Giroudon
- Service de Documentation Centrale, Hospices Civils de Lyon, 69000, Lyon, France
| | - Delphine Cabelguenne
- Service Pharmacie, Unité des dispositifs médicaux, Hospices Civils de Lyon, Hôpital Lyon Sud, 69000, Lyon, France
| | - Xavier Armoiry
- Délégation à la Recheche Clinique et à l'Innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.,Faculté de Pharmacie (ISPB), UMR CNRS 5510 MATEIS, Université de Lyon, 69000, Lyon, France.,Division of Health Sciences, University of Warwick, Coventry, UK
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18
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de Lacy FB, Taurà P, Arroyave MC, Trépanier JS, Ríos J, Bravo R, Ibarzabal A, Pena R, Deulofeu R, Lacy AM. Impact of pneumoperitoneum on intra-abdominal microcirculation blood flow: an experimental randomized controlled study of two insufflator models during transanal total mesorectal excision : An experimental randomized multi-arm trial with parallel treatment design. Surg Endosc 2020; 34:4494-4503. [PMID: 31701284 DOI: 10.1007/s00464-019-07236-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 10/28/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare changes in microcirculation blood flow (MCBF) between pulsatile and continuous flow insufflation. Transanal total mesorectal excision (TaTME) was developed to improve the quality of the resection in rectal cancer surgery. The AirSeal IFS® insufflator facilitates the pelvic dissection, although evidence on the effects that continuous flow insufflation has on MCBF is scarce. METHODS Thirty-two pigs were randomly assigned to undergo a two-team TaTME procedure with continuous (n = 16) or pulsatile insufflation (n = 16). Each group was stratified according to two different pressure levels in both the abdominal and the transanal fields, 10 mmHg or 14 mmHg. A generalized estimating equations (GEE) model was used. RESULTS At an intra-abdominal pressure (IAP) of 10 mmHg, continuous insufflation was associated with a significantly lower MCBF reduction in colon mucosa [13% (IQR 11;14) vs. 21% (IQR 17;24) at 60 min], colon serosa [14% (IQR 9.2;18) vs. 25% (IQR 22;30) at 60 min], jejunal mucosa [13% (IQR 11;14) vs. 20% (IQR 20;22) at 60 min], renal cortex [18% (IQR 15;20) vs. 26% (IQR 26;29) at 60 min], and renal medulla [15% (IQR 11;20) vs. 20% (IQR 19;21) at 90 min]. At an IAP of 14 mmHg, MCBF in colon mucosa decreased 23% (IQR 14;27) in the continuous group and 28% (IQR 26;31) in the pulsatile group (p = 0.034). CONCLUSION TaTME using continuous flow insufflation was associated with a lower MCBF reduction in colon mucosa and serosa, jejunal mucosa, renal cortex, and renal medulla compared to pulsatile insufflation.
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Affiliation(s)
- F Borja de Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Universitat de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain.
| | - Pilar Taurà
- Department of Anesthesiology, Hospital Clinic, Barcelona, Spain
| | | | - Jean-Sébastien Trépanier
- Department of General Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - José Ríos
- Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic, Barcelona, Spain.,Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raquel Bravo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Universitat de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Ainitze Ibarzabal
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Universitat de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Romina Pena
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Universitat de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Ramon Deulofeu
- Biochemistry and Pathology, Centre de Diagnòstic Biomèdic, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Antonio M Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Centro de Investigación biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Barcelona, Spain
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19
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Vaishnav D, Patel B. Laparoscopic Gastrointestinal Surgery During COVID-19 Pandemic: Single-Center Experience. J Laparoendosc Adv Surg Tech A 2020; 31:455-457. [PMID: 32915094 DOI: 10.1089/lap.2020.0481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: COVID-19 era has put laparoscopic surgery a risk procedure because of theoretical risk of viral transmission of COVID-19. However, safe evacuation of stagnant air during laparoscopic surgery is also necessary to safeguard health care warriors. Methods: We are reporting experience of 24 laparoscopic surgeries using a closed smoke evacuation/filtration system using a ultra low-particulate air (ULPA) filtration capability (ConMed AirSeal® System) at a single center between March 22, 2020, and May 30, 2020. All surgeries were either urgent or emergency in nature. Results: Totally, 17 males and 7 females who required urgent surgery. Most common indication for laparoscopic intervention was acute cholecystitis and complications related to acute cholecystitis. Owing to the closed smoke evacuation system, low intra-abdominal pressure was maintained during all surgeries. Of all procedures, only 0.8 time per procedure, the laparoscope taken out for cleaning. Mean time for completion of surgery was 58 minutes. Compliance of surgical staff was high due to the deemed safe smoke evacuation system. Mean of postoperative pain score was low. Mean hospital stay was 4.9 days. Conclusions: We propose to use a closed smoke evacuation/filtration system with ULPA filtration capability or similar devices in each minimally invasive surgery to reduce risks of transmission as minute as possible until we have enough knowledge about the pattern of disease transmission.
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Affiliation(s)
- Dhaivat Vaishnav
- Department of GI and HPB surgery, Zydus Hospital, Ahmedabad, India
| | - Bhavin Patel
- Department of GI and HPB surgery, Zydus Hospital, Ahmedabad, India
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20
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Luketina R, Luketina TLH, Antoniou SA, Köhler G, Könneker S, Manzenreiter L, Wundsam H, Koch OO, Knauer M, Emmanuel K. Prospective randomized controlled trial on comparison of standard CO 2 pressure pneumoperitoneum insufflator versus AirSeal®. Surg Endosc 2020; 35:3670-3678. [PMID: 32767145 PMCID: PMC7412773 DOI: 10.1007/s00464-020-07846-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022]
Abstract
Background AirSeal® is a valve-free insufflation system that enables a stable pneumoperitoneum with continuous smoke evacuation and CO2 recirculation during laparoscopic surgery. Comparative evidence on the use of AirSeal® and standard CO2 insufflator in laparoscopic general surgery procedures is scarce. The aim of this study was to compare surgical outcomes between AirSeal® and standard CO2 insufflators in patients undergoing the most frequently performed laparoscopic procedures. Methods One hundred and ninety-eight patients undergoing elective laparoscopic cholecystectomy, colorectal surgery and hernia repair were randomized to either AirSeal® (group A) or standard pressure CO2 insufflator (group S). The primary endpoints were operative time and level of postoperative shoulder tip pain (Visual Analog Scale). Secondary outcomes included Clavien–Dindo grade complications, surgical side effect and length of hospital stay. Results Patients were randomized to either group A (n = 101) or group S (n = 97) and were analyzed by intention-to-treat. There was no significant difference in mean operative time between the groups (median [IQR]; 71 min [56–94] in group A vs. 69 min [52–93] in group S; p = 0.434). Shoulder tip pain levels were significantly lower in group S (VAS 0 [0–3] in group S vs. 2 [0–4] in group A; p = 0.001). There was no significant difference in complications, surgical side effects (subcutaneous emphysema was not observed in any group) and length of hospital stay. Conclusion This randomized controlled trial showed that using the AirSeal® system did not reduce operative time and was associated with a higher postoperative shoulder tip pain compared to standard CO2 insufflator for short elective surgeries. ClinicalTrials.gov (NCT01740011).
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Affiliation(s)
- Rosalia Luketina
- Department Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany.
| | - Theodore L H Luketina
- Department of Anaesthesia & Intensive Care Medicine, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland
| | - Stavros A Antoniou
- Department of Surgery, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Gernot Köhler
- Department of General and Visceral Surgery, Congregation Hospital (Sisters of Charity), Ordensklinikum Linz, Austria
| | - Sören Könneker
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hanover, Germany
| | - Lisa Manzenreiter
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Helwig Wundsam
- Department of General and Visceral Surgery, Congregation Hospital (Sisters of Charity), Ordensklinikum Linz, Austria
| | - Oliver Owen Koch
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Michael Knauer
- Breast Center Ostschweiz, Schuppistrasse 10, 9016, St. Gallen, Switzerland
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
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21
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Feng TS, Heulitt G, Islam A, Porter JR. Comparison of valve-less and standard insufflation on pneumoperitoneum-related complications in robotic partial nephrectomy: a prospective randomized trial. J Robot Surg 2020; 15:381-388. [PMID: 32632561 DOI: 10.1007/s11701-020-01117-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022]
Abstract
To prospectively compare standard and valve-less insufflation systems on pneumoperitoneum-related complications in robotic-assisted laparoscopic partial nephrectomy. A prospective randomized controlled trial was conducted during a 1.5-year period to compare insufflation-related complications in partial nephrectomy surgery by a single surgeon. Thirty-one patients were recruited for each group: AirSeal insufflation system at 12 mmHg (AIS12), AirSeal at 15 mmHg (AIS15), and conventional insufflation system at 15 mmHg (CIS). Primary outcome assessed was rate of subcutaneous emphysema. Secondary outcomes included rates of pneumothorax, pneumomediastinum, shoulder pain scores, overall pain scores, pain medication usage, insufflation time, recovery room time, length of hospital stay and impact of surgical approach. Predictors for subcutaneous emphysema were assessed with univariate and multivariate logistic models. 93 patients with similar baseline characteristics were randomized into the three insufflation groups. Incidence of subcutaneous emphysema was lower in the AIS12 group compared to CIS (19% vs 48%, p = 0.03,). Mean pain score was less for AIS12 compared to CIS at 12 h (3.1 vs 4.4, p = 0.03). Shoulder pain was less in AIS12 and AIS15 groups compared to CIS at 8 h (AIS12 vs CIS: 0.6 vs 1.6, p = 0.01, AIS15 vs CIS: 0.6 vs 1.6, p = 0.02), and between AIS12 as compared to CIS at 12 h (0.4 vs 1.4, p = 0.003) postoperatively. There was no difference between morphine equivalent use, insufflation time, recovery room time, and length of hospital stay. Multivariable regression analysis showed AirSeal at 12 mmHg and the transperitoneal approach to be the only significant predictors for lower risk of developing subcutaneous emphysema (p < 0.001). Compared to standard insufflation, AirSeal insufflation at 12 mmHg was associated with reduced risk of developing subcutaneous emphysema in robotic partial nephrectomy. Furthermore, shoulder pain was reduced in both AirSeal groups compared to standard insufflation. The retroperitoneal approach increases the risk of developing subcutaneous emphysema.
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Affiliation(s)
- Tom S Feng
- Swedish Medical Center, 1101 Madison St, Suite 1400, Seattle, WA, 98104, USA
| | - Gerald Heulitt
- Swedish Medical Center, 1101 Madison St, Suite 1400, Seattle, WA, 98104, USA
| | - Adel Islam
- Swedish Medical Center, 1101 Madison St, Suite 1400, Seattle, WA, 98104, USA
| | - James R Porter
- Swedish Medical Center, 1101 Madison St, Suite 1400, Seattle, WA, 98104, USA.
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22
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Paull JO, Parsacandola SA, Graham A, Hota S, Pudalov N, Obias V. The impact of the AirSeal ® valve-less trocar system in robotic colorectal surgery: a single-surgeon retrospective review. J Robot Surg 2020; 15:87-92. [PMID: 32333365 DOI: 10.1007/s11701-020-01071-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traditional trocar systems suffer from several innate flaws due to their silicone seal design. The AirSeal® is a valve-less trocar system that overcomes these flaws by utilizing a system of laminar flow and CO2 recirculation. The purpose of this paper is to examine the effect of the AirSeal® versus a traditional trocar system in operative time, EBL and post-operative complications. To the best of our knowledge, this is the first analysis of this system in robotic colorectal surgery. METHODS A single surgeon's database was reviewed and all LAR and right hemicolectomy robotic cases from 2014-2015 and 2017-2018 were included for analysis. Patient demographic information was evaluated and primary outcomes examined were operative time, EBL, post-operative complications and hospital LOS. RESULTS Ninety four patients were identified in the LAR cohort and 56 patients were identified in the right hemicolectomy cohort. Mean operative time for LAR was 293 ± 91.6 min in 2014-2015 and 232 ± 74.6 min in 2017-2018 (p = 0.001); however, this significant difference was not seen between right hemicolectomies. Mean EBL for LAR was 209 ± 189 cc in 2014-2015 and 150 ± 173.9 cc in 2017-2018 (p = 0.05); again, this significant difference was not appreciated for right hemicolectomies. There was no statistically significant difference in rates of wound infections, pneumonia, post-operative pneumonia, DVT/PE, intra-abdominal/pelvic abscesses, or unplanned 30-day readmission rate between 2014-2015 and 2017-2018. Length of stay was reduced in both populations between 2014-2015 and 2017-2018; however, it neither reached statistical significance. CONCLUSION In patients undergoing low anterior resections, the AirSeal® trocar system demonstrated a statistically significant reduction in mean operative time and EBL compared to the traditional trocar system. There was also a trend towards decreased length of stay and post-operative complications with AirSeal® use in low anterior resections and right hemicolectomies. In patients undergoing distal colorectal procedures, the AirSeal® trocar system should be considered.
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Affiliation(s)
- Jessie Osborne Paull
- Walter Reed National Military Medical Center, C/O George Washington University Hospital, 22nd and I Street, NW, 9th Floor Suite 6B, Washington, DC, 20037, USA
| | - Salvatore A Parsacandola
- Walter Reed National Military Medical Center, C/O George Washington University Hospital, 22nd and I Street, NW, 9th Floor Suite 6B, Washington, DC, 20037, USA.
| | - Ada Graham
- Department of Colorectal Surgery, George Washington University Hospital, Washington, USA
| | - Salini Hota
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Natalie Pudalov
- George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Vincent Obias
- Department of Colorectal Surgery, George Washington University Hospital, Washington, USA
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23
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Ha HI, Choi MC, Jung SG, Joo WD, Lee C, Song SH, Park H. Chemicals in Surgical Smoke and the Efficiency of Built-in-Filter Ports. JSLS 2020; 23:JSLS.2019.00037. [PMID: 31787836 PMCID: PMC6853788 DOI: 10.4293/jsls.2019.00037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Surgical smoke contains various malodorous and hazardous combustion byproducts. We aimed to analyze hydrocarbons accumulated in the abdominal cavity during laparoscopic gynecologic surgery and determine the efficiency of a built-in-filter port. Methods: We prospectively followed seven patients with benign uterine pathology. Surgical smoke was generated using laparoscopic or robotic electrocautery. The smoke was collected twice for each patient using a built-in-filter port and a conventional port. The concentrations of volatile organic compounds and aldehydes were determined using gas chromatography with mass spectrometry and high-performance liquid chromatography with ultraviolet visible light detection and compared using the paired-sample Wilcoxon signed-rank test. Results: Five volatile organic compounds and five aldehydes had toxic effects or unpleasant odors. The median concentration of formaldehyde before filtration (0.870 ppm) exceeded the time-weighted average concentration (0.75 ppm) of the Occupational Safety and Health Administration. Built-in-filter ports significantly reduced the concentration of five volatile organic compounds and two aldehydes but not that of formaldehyde, acetaldehyde, and propionaldehyde. Formaldehyde concentration decreased by 50% after filtration but remained above the recommended exposure limit (0.016 ppm) of the National Institute of Occupational Safety and Health. Conclusions: Surgical smoke in minimally invasive gynecologic procedures contains several hazardous hydrocarbons including formaldehyde. Built-in-filter ports have the potential to reduce the exposure of surgical smoke to surgeons and operating room personnel; nevertheless, development of built-in-filter ports is necessary to improve the filtering efficiency for highly concentrated formaldehydes.
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Affiliation(s)
- Hyeong In Ha
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Ilsan, Goyang-si, Republic of Korea
| | - Min Chul Choi
- Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sang Geun Jung
- Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Won Duk Joo
- Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Chan Lee
- Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Seung Hun Song
- Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hyun Park
- Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
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24
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Vigneswaran Y, Prachand VN, Posner MC, Matthews JB, Hussain M. What Is the Appropriate Use of Laparoscopy over Open Procedures in the Current COVID-19 Climate? J Gastrointest Surg 2020; 24:1686-1691. [PMID: 32285338 PMCID: PMC7153352 DOI: 10.1007/s11605-020-04592-9] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Among surgeons worldwide, a concern with the use of minimally invasive techniques has been raised due to a proposed risk of viral transmission of the coronavirus disease of 2019 (COVID-19) with the creation of pneumoperitoneum. Due to this proposed concern, we sought to collect the available data and evaluate the use of laparoscopy and the risk of COVID-19 transmission. METHODS A literature review of viral transmission in surgery and of the available literature regarding the transmission of the COVID-19 virus was performed. We additionally reviewed surgical society guidelines and recommendations regarding surgery during this pandemic. RESULTS Few studies have been performed on viral transmission during surgery, but to date there is no study that demonstrates or can suggest the ability for a virus to be transmitted during surgical treatment whether open or laparoscopic. There is no societal consensus on limiting or restricting laparoscopic or robotic surgery; however, there is expert consensus on the modification of standard practices to minimize any risk of transmission. CONCLUSIONS Despite very little evidence to support viral transmission through laparoscopic or open approaches, we recommend making modifications to surgical practice such as the use of smoke evacuation and minimizing energy device use among other measures to minimize operative staff exposure to aerosolized particles.
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Affiliation(s)
- Yalini Vigneswaran
- Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland, Rm. G-210, Chicago, IL 60637 USA
| | - Vivek N. Prachand
- Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland, Rm. G-210, Chicago, IL 60637 USA
| | - Mitchell C. Posner
- Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland, Rm. G-210, Chicago, IL 60637 USA
| | - Jeffrey B. Matthews
- Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland, Rm. G-210, Chicago, IL 60637 USA
| | - Mustafa Hussain
- Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland, Rm. G-210, Chicago, IL 60637 USA
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25
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Upadhyaya V, Rahul S, Gupta M, Chaubey D, Kumar D, Keshri R, Kumar V. Pediatric surgery during coronavirus disease lockdown: Multicenter experience from North India. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_100_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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26
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Effects of lung protective ventilation on postoperative respiratory parameters in patients undergoing robot-assisted radical prostatectomy. J Robot Surg 2019; 14:509-516. [PMID: 31506877 DOI: 10.1007/s11701-019-01016-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/22/2019] [Indexed: 02/02/2023]
Abstract
To investigate the effects of lung protective ventilation (LPV) compared to conventional ventilation (CV) on postoperative respiratory parameters in patients undergoing robot-assisted radical prostatectomy (RARP). In total, 24 patients undergoing RARP were randomized to two groups receiving either LPV with a tidal volume of 6 ml/IBW with a positive end-expiratory pressure (PEEP) of 10 cm H2O (intervention) or CV with a tidal volume of 10 ml/IBW with a PEEP of 4 cmH2O (control). Primary endpoint was PaO2 2 h postoperatively after 10 min of spontaneous respiration of atmospheric air. Forced expiratory volume during the first second (FEV1), forced vital capacity (FVC), diffusion capacity (DLCO), and plasma interleukin-6 (IL-6) was measured before and after the surgery. Pulmonary complications were registered within the first year after surgery. All patients completed the study. No difference was found in PaO2 between LPV and CV. However, 4 patients in the LPV group had a decrease in saturation below 90% during the 10 min of spontaneous respiration of atmospheric air compared to none in the CV group. FEV1, FVC, and DLCO were similar when comparing the two groups at all timepoints and no patients in either of the groups had pulmonary complications during the first postoperative year. IL-6 levels increased during surgery in both groups, but were not significantly different between the two groups. We found no evidence of lung protective effects of LPV compared to CV estimated by pulmonary function tests, IL-6 levels and postoperative complications in patients undergoing RARP. Surprisingly, only patients in the LPV group and none in the CV group had a decline in saturation below 90% during the 10 min of breathing atmospheric air.
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27
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de’Angelis N, Abdalla S, Carra MC, Lizzi V, Martínez-Pérez A, Habibi A, Bartolucci P, Galactéros F, Laurent A, Brunetti F. Low-impact laparoscopic cholecystectomy is associated with decreased postoperative morbidity in patients with sickle cell disease. Surg Endosc 2017; 32:2300-2311. [PMID: 29098436 DOI: 10.1007/s00464-017-5925-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/08/2017] [Indexed: 01/05/2023]
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28
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Aloisi A, Pesce JE, Paraghamian SE, Chi DS, Rieth EF. Bilateral Otorrhagia after Robotically Assisted Gynecologic Surgery in the Setting of a Reduced Trendelenburg Position and Low-Pressure Pneumoperitoneum: A Case Report and Review of the Literature. J Minim Invasive Gynecol 2017; 24:1229-1233. [PMID: 28461176 DOI: 10.1016/j.jmig.2017.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/21/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
Abstract
Perioperative otorrhagia in association with nonotolaryngologic surgery is rare. The cause is typically attributed to the physiologic derangements associated with the Trendelenburg position and pneumoperitoneum during laparoscopic surgery. The most well-accepted etiology is an increase in arterial and venous pressures causing the rupture of subcutaneous capillaries, although the exact etiology remains unclear. We present the first reported case of bilateral spontaneous otorrhagia associated with robotically assisted laparoscopic surgery involving a reduced Trendelenburg position and low-pressure pneumoperitoneum. Perioperative hypertension, female gender, advanced age, and increased bleeding risk may contribute to the development of this rare complication.
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Affiliation(s)
- Alessia Aloisi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julianna E Pesce
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sarah E Paraghamian
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California Irvine Medical Center, Orange, California
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Elizabeth F Rieth
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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