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Zhi W, Wang Y, Wang L, Yang L. Comparative assessment of safety and efficacy between the AirSeal system and conventional insufflation system in robot-assisted laparoscopic radical prostatectomy: a systematic review and meta-analysis. J Robot Surg 2024; 18:291. [PMID: 39042265 DOI: 10.1007/s11701-024-02000-x] [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: 05/08/2024] [Accepted: 05/27/2024] [Indexed: 07/24/2024]
Abstract
This meta-analysis aimed to compare perioperative outcome measures between the AirSeal system and conventional insufflation system in robot-assisted laparoscopic prostatectomy. Up to May 2024, comprehensive searches were conducted across various prominent databases worldwide, such as PubMed, Embase, and Google Scholar, focusing solely on English-language materials. Reviews and protocols devoid of published data were excluded, along with conference abstracts and articles unrelated to the study's aims. Primary outcome measures encompassed operative duration and hospitalization length, while secondary outcome measures included estimated blood loss and complications. The meta-analysis included five cohort studies, encompassing a total of 1503 patients. In comparison to the conventional insufflation system group, the AirSeal group displayed shorter operative times (WMD - 15.62, 95% CI - 21.87 to - 9.37; p < 0.00001) and reduced hospital stays (WMD - 0.45, 95% CI - 0.60 to - 0.30; p < 0.00001). Fewer major complications (OR 0.15, 95% CI 0.03 to 0.66; p = 0.01). Notably, there were no significant differences observed in estimated blood loss or overall complications between the two groups. Compared to conventional insufflation systems, employing the AirSeal system in robot-assisted laparoscopic radical prostatectomy appears to potentially decrease operative time and hospital length of stay without a concurrent rise in estimated blood loss or complication rates.
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Affiliation(s)
- Wen Zhi
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Department of Urology, Langzhong People's Hospital, Langzhong, Sichuan, China
| | - Yu Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Li Wang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Le Yang
- Department of Urology, Langzhong People's Hospital, Langzhong, Sichuan, China.
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Chien AL, Doppalapudi SK, Pfail JL, Lee G, Mikhail M, Ahuja B, Tito ET, Shah U, Barone J, Ahmed H, Elsamra S. Comparison of a Valveless Trocar System and Conventional Insufflation in Pediatric Urologic Surgery. J Endourol 2024; 38:47-52. [PMID: 37819689 DOI: 10.1089/end.2023.0181] [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] [Indexed: 10/13/2023] Open
Abstract
Background: Conventional operative insufflation uses a one-way trocar to handle instruments while maintaining pneumoperitoneum. In 2007, the AirSeal® valveless trocar insufflation system was introduced, which maintains stable pneumoperitoneum while continuously evacuating smoke. Although this device has been validated in adult patients, it has not been extensively validated in the pediatric population. Materials and Methods: A retrospective cohort study of pediatric urology patients aged 0 to 21 who underwent laparoscopic pyeloplasty between March 2016 and October 2021 was performed. Intraoperative physiologic parameters, procedure characteristics, postoperative outcomes, and demographics of each patient in whom either AirSeal insufflation system (AIS) or conventional insufflation system (CIS) was utilized were obtained from hospital records. Data were compared across the AIS and CIS cohorts. The primary outcomes were intraoperative anesthetic and physiologic parameters, including end tidal carbon dioxide, oxygen saturation, body temperature, positive inspiratory pressure, systolic blood pressure, and heart rate. Results: There were no significant differences in the anesthetic and physiologic parameters in the AIS and CIS groups. In addition, no differences in demographics, procedural characteristics, or complication rates were found between the cohorts. Conclusion: The AirSeal valveless trocar insufflation system demonstrates comparable intraoperative anesthetic and physiologic outcomes compared to conventional one-way valve insufflation in pediatric laparoscopic pyeloplasty. Certain surgeon-related qualitative metrics are underappreciated in this study, however, including improved visualization with vigorous suctioning and pressure maintenance with frequent instrument exchanges. Surgeon experience may mask the benefits of these characteristics as it pertains to quantitative surgical outcomes such as estimated blood loss, operative time, and perioperative complications.
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Affiliation(s)
- Austin L Chien
- Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Sai Krishnaraya Doppalapudi
- Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - John L Pfail
- Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Grace Lee
- Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Mark Mikhail
- Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Brittany Ahuja
- Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Emmanuel Tadjou Tito
- Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Usman Shah
- Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Joseph Barone
- Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Haris Ahmed
- Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Sammy Elsamra
- Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Robertson D, Sterke F, van Weteringen W, Arezzo A, Mintz Y, Horeman T. Escape of surgical smoke particles, comparing conventional and valveless trocar systems. Surg Endosc 2023; 37:8552-8561. [PMID: 37794124 PMCID: PMC10615925 DOI: 10.1007/s00464-023-10444-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/02/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND During minimal access surgery, surgical smoke is produced which can potentially be inhaled by the surgical team, leading to several health risks. This smoke can escape from the abdominal cavity into the operating room due to trocar leakage. The trocars and insufflator that are used during surgery influence gas leakage. Therefore, this study compares particle escape from a valveless (Conmed AirSeal iFS), and a conventional (Karl Storz Endoflator) system. MATERIALS AND METHODS Using an in vitro model, a conventional and a valveless trocar system were compared. A protocol that simulated various surgical phases was defined to assess the surgical conditions and particle leakage. Insufflation pressures and instrument diameters were varied as these are known to affect gas leakage. RESULTS The conventional trocar leaked during two distinct phases. Removal of the obturator caused a sudden release of particles. During instrument insertion, an average of 211 (IQR 111) particles per second escaped when using the 5 mm diameter instrument. With the 10 mm instrument, 50 (IQR 13) particles per second were measured. With the conventional trocar, a higher abdominal pressure increased particle leakage. The valveless trocar demonstrated a continuously high particle release during all phases. After the obturator was removed, particle escape increased sharply. Particle escape decreased to 1276 (IQR 580) particles per second for the 5 mm instrument insertion, and 1084 (IQR 630) particles per second for 10 mm instrument insertion. With the valveless trocar system, a higher insufflation pressure lowered particle escape. CONCLUSIONS This study shows that a valveless trocar system releases more particles into the operating room environment than a conventional trocar. During instrument insertion, the leakage through the valveless system is 6 to 20 times higher than the conventional system. With a valveless trocar, leakage decreases with increasing pressure. With both trocar types leakage depends on instrument diameter.
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Affiliation(s)
- Daniel Robertson
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.
| | - Frank Sterke
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem van Weteringen
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Anesthesiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Yoav Mintz
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tim Horeman
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
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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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Katoh H, Ikeda Y, Saito Y, Yokota M, Kikuchi M, Sengoku N, Fujisaki K, Sangai T. The Usefulness of AirSeal™ Intelligent Flow System in Gas Insufflation Total Endoscopic Thyroidectomy. Indian J Otolaryngol Head Neck Surg 2023; 75:115-120. [PMID: 37007898 PMCID: PMC10050613 DOI: 10.1007/s12070-022-03257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/23/2022] [Indexed: 11/07/2022] Open
Abstract
Total endoscopic thyroidectomy (TET) using low CO2 insufflation provides cosmetic advantage, excellent working space and visibility. On the contrary, suctioning blood or mist/smoke produced by energy device application causes narrowing of working space especially in neck surgery. In this regard, AirSeal intelligent flow system would be particularly suitable in TET. However, the benefit of AirSeal is unknown in TET unlike abdominal surgery. Therefore, the impact of AirSeal was evaluated in TET in this study. Twenty patients who underwent total endoscopic hemithyroidectomy were retrospectively analyzed. Insufflation was conducted by either conventional or AirSeal system according to the surgeon's preference. Short-term surgical outcomes including operation time, bleeding, frequency of scope cleaning, and disappearance of subcutaneous emphysema were compared as well as actual visibility. AirSeal application dramatically reduced obstacle smoke/mist and prevented narrowing working space by suctioning. Frequency of scope cleaning was significantly less in AirSeal group than that in conventional group (p = 0.016). In patients with nodule < 5 cm, intraoperative hemorrhage was less in AirSeal group than that in the counterpart (p = 0.077) regardless of larger nodule size in AirSeal group (p = 0.058). Notably, subcutaneous emphysema around surgical cavity disappeared significantly earlier in AirSeal group than in the counter parts (p = 0.019). On the contrary, AirSeal application did not shorten operation time in the current study. AirSeal provided excellent visibility and seamless operation. AirSeal has great potential to decrease not only surgeon's stress but surgical invasion on patients. The results in this study give rational to AirSeal application to TET. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03257-0.
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Affiliation(s)
- Hiroshi Katoh
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Yoshifumi Ikeda
- Department of Surgery, International University of Health and Welfare, Atami Hospital, Atami, Japan
| | - Yoshiyuki Saito
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuo Yokota
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Mariko Kikuchi
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Norihiko Sengoku
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Kaoru Fujisaki
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Takafumi Sangai
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374 Japan
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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: 2] [Impact Index Per Article: 2.0] [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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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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Smoke and particulate filters in endoscopic surgery reviewed during COVID-19 pandemic. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s42804-020-00060-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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10
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Shahait M, Cockrell R, Yezdani M, Yu SJ, Lee A, McWilliams K, Lee DI. Improved Outcomes Utilizing a Valveless-Trocar System during Robot-assisted Radical Prostatectomy (RARP). JSLS 2019; 23:JSLS.2018.00085. [PMID: 30740014 PMCID: PMC6364705 DOI: 10.4293/jsls.2018.00085] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction To evaluate the effect of valveless trocar system (VTS) on intra-operative parameters, peri-operative outcomes, and 30-day postoperative complications in patients undergoing robotic-assisted laparoscopic prostatectomy. Methods A total of 200 consecutive patients undergoing Robot-assisted radical prostatectomy by a single surgeon were prospectively evaluated using either the valveless trocar (n = 100) or standard trocars (n = 100). Patient demographics, intra-operative parameters, length of stay, presence or absence of postoperative nausea and vomiting, analog pain score at 0-6 hours, 6-12 hours, 12-18 hours, and >24 hours, and 30-day postoperative complications were analyzed. Results There were no significant differences in estimated blood loss, intra-operative urine output, length of stay, or 30-day complication rates between the two groups. While the VTS group had higher Body Mass Index (BMI) (28.45 vs. 27.23; P = 0.049), the operative time was significantly shorter in the VTS group (146 minutes vs. 167 minutes; P < .005). The VTS group experienced fewer episodes of nausea (2% vs. 10%; P = 0.0172). The VTS group had less pain intensity compared to the control in the first 18 hours: 0-6 hours (1.9 vs. 2.5; P = 0.034), 6-12 hours (2.8 vs. 3.6; P = 0.044), and 12-18 hours (2.2 vs. 3.1; P = 0.049), respectively. Conclusion The use of a valveless trocar system during robot-assisted robotic prostatectomy may shorten operative times, and reduce postoperative pain scores and nausea episodes without increasing the 30-day complication rate. Further prospective randomized trials should be performed to validate these findings.
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Affiliation(s)
- Mohammed Shahait
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, PA
| | - Ross Cockrell
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, PA
| | - Mona Yezdani
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, PA
| | - Sue-Jean Yu
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, PA
| | - Alexandra Lee
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, PA
| | - Kellie McWilliams
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, PA
| | - David I Lee
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, PA
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Covotta M, Claroni C, Torregiani G, Naccarato A, Tribuzi S, Zinilli A, Forastiere E. A Prospective, Randomized, Clinical Trial on the Effects of a Valveless Trocar on Respiratory Mechanics During Robotic Radical Cystectomy. Anesth Analg 2017; 124:1794-1801. [DOI: 10.1213/ane.0000000000002027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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12
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Sroussi J, Elies A, Rigouzzo A, Louvet N, Mezzadri M, Fazel A, Benifla JL. Low pressure gynecological laparoscopy (7mmHg) with AirSeal ® System versus a standard insufflation (15mmHg): A pilot study in 60 patients. J Gynecol Obstet Hum Reprod 2017; 46:155-158. [PMID: 28403972 DOI: 10.1016/j.jogoh.2016.09.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/25/2016] [Accepted: 09/29/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate feasibility of performing benign gynecologic pathology low pressure (7mmHg) laparoscopy (LPL) with AirSeal® system and to study benefits in terms of postoperative pain, when compared to a standard insufflation group (15mmHg). MATERIALS AND METHODS In this prospective randomized pilot study, 60 patients had laparoscopy for gynecologic benign pathology: 30 with 7mmHg and AirSeal system, and 30 with 15mmHg standard insufflator. The primary endpoint was incidence of shoulder pain. A postoperative questionnaire was completed by each patient to assess shoulder pain (Numeric Rating Scale [NRS], from 0 to 10) at H4, H8, H24, and consumption of morphinics was notified. During each procedure, anesthesia parameters were collected (peak airway pressure, systolic blood pressure, end tidal CO2). RESULTS Laparoscopy was performed on 30 patients in AirSeal®-LP group without need to increase pressure above 7mmHg, and no complication was reported. Incidence of shoulder pain was significantly lower in the AirSeal®-LP group (23.3% vs. 73.3%, P<0.001). NRS shoulder pain was significantly lower in AirSeal® LP group at hour 4, 8 and 24. Maximal values of ETCO2, systolic blood pressure, and peak airway pressure were significantly lower in AirSeal®-LP group. CONCLUSION LP (7mmHg) laparoscopy with AirSeal® platform allows laparoscopic surgery with less postoperative shoulder pain. These results could facilitate the development of ambulatory laparoscopy.
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Affiliation(s)
- J Sroussi
- Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Department of Gynecology and Obstetrics, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France.
| | - A Elies
- Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Department of Gynecology and Obstetrics, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France
| | - A Rigouzzo
- Department of Anesthesiology and Intensive Care, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France
| | - N Louvet
- Department of Anesthesiology and Intensive Care, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France
| | - M Mezzadri
- Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Department of Gynecology and Obstetrics, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France
| | - A Fazel
- Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France
| | - J-L Benifla
- Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Department of Gynecology and Obstetrics, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France
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Robotic partial nephrectomy performed with Airseal versus a standard CO 2 pressure pneumoperitoneum insufflator: a prospective comparative study. Surg Endosc 2016; 31:1583-1590. [PMID: 27495337 DOI: 10.1007/s00464-016-5144-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Airseal represents a new generation of valveless and barrier-free surgical trocars that enable a stable pneumoperitoneum with continuous smoke evacuation and carbon dioxide (CO2) recirculation during surgery. The aim of the current study was to evaluate the potential advantages of the Airseal compared to a standard CO2 insufflator in the field of robotic partial nephrectomy (RPN). METHODS Between October 2012 and April 2015, two cohorts of 122 consecutive patients with clinically localized renal cell carcinoma underwent RPN by a single surgeon, with the use of a standard CO2 pressure insufflator (Group A, 55 patients) or Airseal (Group B, 67 patients) and were prospectively compared. RESULTS The two groups were similar in baseline, preoperative characteristics. The mean dimension of the lesion, as evaluated by contrast-enhanced CT scan, was 30 (median 28; IQR 2) and 39 mm (median 40; IQR 2) for Groups A and B, respectively (p < 0.05). The complexity of the treated tumors was similar, as indicated by the mean RENAL nephrometry score. Positive surgical margins rate was similar in both groups (3.6 vs 4.5 %, p = 0.8) as well as the need for postoperative blood transfusion (9.1 vs 4.5 %, p = 0.3) and the development of postoperative acute kidney injury (16.4 vs 10.4 %, p = 0.3). Mean operative time and warm ischemia time were significantly shorter in Group B. Moreover, a significant increase in the cases performed as "zero ischemia" was observed in Group B (7.3 vs 30 %, p < 0.01). CONCLUSIONS This is the first study comparing the Airseal with a standard CO2 insufflator system in the field of the RPN. The preliminary outcomes in terms of overall operative time, warm ischemia time and cases performed as "zero ischemia" are better with respect to standard insufflators. The feasibility, safety and efficacy of combining laser tumor enucleation with the valve-free insufflation systems should be evaluated.
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14
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Gaunay GS, Elsamra SE, Richstone L. Trocars: Site Selection, Instrumentation, and Overcoming Complications. J Endourol 2016; 30:833-43. [DOI: 10.1089/end.2016.0128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Geoffrey S. Gaunay
- The Smith Institute for Urology, Hofstra University School of Medicine, Northwell Health, New Hyde Park, New York
| | - Sammy E. Elsamra
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Lee Richstone
- The Smith Institute for Urology, Hofstra University School of Medicine, Northwell Health, New Hyde Park, New York
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15
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Comparison of Pneumoperitoneum Stability Between a Valveless Trocar System and Conventional Insufflation: A Prospective Randomized Trial. Urology 2016; 94:274-80. [PMID: 27130263 DOI: 10.1016/j.urology.2016.04.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 01/29/2016] [Accepted: 04/09/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the variation in pneumoperitoneum and physiologic effects of patients undergoing laparoscopic renal surgery using the valveless trocar insufflation system (VI) vs a conventional insufflation system (CI). METHODS AND MATERIALS We conducted a single-center, randomized controlled trial in patients undergoing renal surgery at 15 mm Hg insufflation using a VI system vs a CI system. The primary outcome measured was variation in insufflation pressure, and end-tidal CO2 at 10 and 25 minutes. RESULTS Fifty-six patients (VI n = 28 or CI n = 28) met inclusion criteria and were randomized. There was significantly less variability in pressure readings, as measured by coefficient of variation, during VI compared to CI (7.8% vs 15.6%, P < .001). There was significantly less time spent within the range with pressure readings ≥18 mm Hg (median 0.2% vs 16.5%, P < .001) and ≤12 mm Hg (median 1.7% vs 5.6%, P = .011) during VI compared to CI. Additionally, there was significantly less time spent with pressure readings in the "unacceptable" range of ≥20 mm Hg (median 0% vs 0.08%, P < .001) and ≤10 mm Hg (median 0.09% vs 2.6%, P < .001) during the cases with VI compared to CI. End-tidal CO2 was significantly lower at 10 minutes (P = .036) after insufflation in the valveless trocar group compared to the conventional treatment group. There were no other significant differences in physiologic metrics. CONCLUSION Compared with a CI, the VI provides a significantly more stable pneumoperitoneum during laparoscopic renal surgery and lower end-tidal CO2 at 10 minutes.
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16
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Miyano G, Morita K, Kaneshiro M, Miyake H, Nouso H, Yamoto M, Koyama M, Nakano R, Tanaka Y, Fukumoto K, Urushihara N. Laparoscopic Toupet Fundoplication using an Air Seal Intelligent Flow System and Anchor Port in a 1.8-kg infant: A Technical Report. Asian J Endosc Surg 2015; 8:357-60. [PMID: 26303738 DOI: 10.1111/ases.12182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/30/2014] [Accepted: 01/28/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We report a case of a 1.8-kg infant who had laparoscopic Toupet fundoplication (LTF) using the AirSeal Intelligent Flow System and Anchor Port (AP). MATERIALS AND SURGICAL TECHNIQUE Our case had severe gastroesophageal reflux in association with genetic and cardiac anomalies. Despite the patient being continuously fed, persistent vomiting caused failure to thrive, and LTF was performed at 4 months of age when he weighed 1.8 kg. The AirSeal Intelligent Flow System is a novel laparoscopic CO2 insufflation system that improves the visual field by constantly evacuating smoke and providing a more stable pneumoperitoneum. The AP is a recently developed, stretchable, elastomeric, low-profile cannula. Three 5-mm AP were inserted: one subumbilically for the scope and one in both the right and left upper abdomen for the surgeon. A 5-mm AirSeal trocar was inserted in the left lower abdomen for the assistant. The gastrosplenic ligament was dissected free, and the intra-abdominal esophagus was prepared. A posterior hiatoplasty was performed, followed by the 270° fundoplication. During the fundoplication, the esophagus was fixed to the crus and then the right and left wraps were fixed to the esophagus. Pneumoperitoneum was maintained stably throughout the LTF procedure, with optimal operative field. Total operating time for LTF was 90 min. Body temperature dropped from 37.4°C to 35.7°C during pneumoperitoneum but resolved once pneumoperitoneum was ceased. Postoperative progress was uneventful, and an upper gastrointestinal study on postoperative day 2 showed no residual gastroesophageal reflux. DISCUSSION We believe the AirSeal Intelligent Flow System and AP contributed to the successful completion of LTF in a 1.8-kg infant.
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Affiliation(s)
- Go Miyano
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Keiichi Morita
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masakatsu Kaneshiro
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiroshi Nouso
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Mariko Koyama
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Reiji Nakano
- Department of Neonatology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Yasuhiko Tanaka
- Department of Neonatology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
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17
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George AK, Wimhofer R, Viola KV, Pernegger M, Costamoling W, Kavoussi LR, Loidl W. Utilization of a novel valveless trocar system during robotic-assisted laparoscopic prostatectomy. World J Urol 2015; 33:1695-9. [PMID: 25725807 DOI: 10.1007/s00345-015-1521-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/23/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the effect of a novel valveless trocar system (VTS) on perioperative outcomes in patients undergoing robotic-assisted laparoscopic prostatectomy (RALP). METHODS A single-institution retrospective review was performed of 792 patients undergoing RALP. Preoperative patient variables, tumor characteristics, and perioperative variables were collected and analyzed. The first 150 patients were excluded from analysis to account for the learning curve of robotic surgery. Univariate and multivariate linear regression models were used to assess factors affecting operative time (ORT). RESULTS A total of 257 and 385 patients underwent RALP utilizing the VTS and conventional insufflation, respectively. There were no significant differences in American Society of Anesthesiologist score, body mass index (BMI), prostate volume, final Gleason score, estimated blood loss, and complications between the cohorts. The only difference noted was a significantly shorter mean ORT in the VTS cohort (149.5 vs. 170.1 min, p < 0.0001). In light of this finding, further analysis was performed to identify associations with ORT. Multivariable analysis demonstrated that VTS, BMI, final Gleason score, prostate volume, surgeon, and node dissection were significantly associated with ORT. The use of the VTS decreased mean ORT by 23.2 min when controlling for confounding factors (p < 0.001). The performance of a nerve sparing operation was found to decrease ORT by 15.9 min (p < 0.001), though more often performed for lower-risk disease. CONCLUSION The use of a novel VTS demonstrated decreased ORT in patients undergoing RALP when controlling for confounding factors. Prospective randomized trials are needed to evaluate its ultimate benefit in various surgical cohorts.
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Affiliation(s)
- Arvin K George
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, 450 Lakeville Rd, Suite M-41, New Hyde Park, NY, 11040, USA.
| | | | - Kate V Viola
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | - Louis R Kavoussi
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, 450 Lakeville Rd, Suite M-41, New Hyde Park, NY, 11040, USA
| | - Wolfgang Loidl
- Krankenhaus der Bamherzigen Schwestern Linz, Linz, Austria
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18
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Abstract
New additional risks factors that may act to increase the risk of subcutaneous emphysema include total gas volume, gas flow rate, valveless trocar systems, and robotic fulcrum forces. Background: Subcutaneous emphysema and gas extravasation outside of the peritoneal cavity during laparoscopy has consequences. Knowledge of the circumstances that increase the potential for subcutaneous emphysema is necessary for safe laparoscopy. Methods: A literature review and a PubMed search are the basis for this review. Conclusions: The known risk factors leading to subcutaneous emphysema during laparoscopy are multiple attempts at abdominal entry, improper cannula placement, loose fitting cannula/skin and fascial entry points, use of >5 cannulas, use of cannulas as fulcrums, torque of the laparoscope, increased intra-abdominal pressure, procedures lasting >3.5 hours, and attention to details. New additional risk factors acting as direct factors leading to subcutaneous emphysema risk and occurrence are total gas volume, gas flow rate, valveless trocar systems, and robotic fulcrum forces. Recognizing this spectrum of factors that leads to subcutaneous emphysema will yield greater patient safety during laparoscopic procedures.
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Affiliation(s)
- Douglas E Ott
- Biomedical Engineering, Mercer University, 109 Preston Court, Macon GA 31210, USA.
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Luketina RR, Knauer M, Köhler G, Koch OO, Strasser K, Egger M, Emmanuel K. Comparison of a standard CO₂ pressure pneumoperitoneum insufflator versus AirSeal: study protocol of a randomized controlled trial. Trials 2014; 15:239. [PMID: 24950720 PMCID: PMC4078359 DOI: 10.1186/1745-6215-15-239] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 06/09/2014] [Indexed: 12/22/2022] Open
Abstract
Background AirSeal™ is a novel class of valve-free insufflation system that enables a stable pneumoperitoneum with continuous smoke evacuation and carbon dioxide (CO2) recirculation during laparoscopic surgery. Comparison data to standard CO2 pressure pneumoperitoneum insufflators is scarce. The aim of this study is to evaluate the potential advantages of AirSeal™ compared to a standard CO2 insufflator. Methods/Design This is a single center randomized controlled trial comparing elective laparoscopic cholecystectomy, colorectal surgery and hernia repair with AirSeal™ (group A) versus a standard CO2 pressure insufflator (group S). Patients are randomized using a web-based central randomization and registration system. Primary outcome measures will be operative time and level of postoperative shoulder pain by using the visual analog score (VAS). Secondary outcomes include the evaluation of immunological values through blood tests, anesthesiological parameters, surgical side effects and length of hospital stay. Taking into account an expected dropout rate of 5%, the total number of patients is 182 (n = 91 per group). All tests will be two-sided with a confidence level of 95% (P <0.05). Discussion The duration of an operation is an important factor in reducing the patient’s exposure to CO2 pneumoperitoneum and its adverse consequences. This trial will help to evaluate if the announced advantages of AirSeal™, such as clear sight of the operative site and an exceptionally stable working environment, will facilitate the course of selected procedures and influence operation time and patients clinical outcome. Trial registration ClinicalTrials.gov NCT01740011, registered 23 November 2012.
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Affiliation(s)
- Ruzica Rosalia Luketina
- Department of General and Visceral Surgery, Krankenhaus der Barmherzigen Schwestern Linz, Seilerstätte 4, Linz 4020, Austria.
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20
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Abstract
Robotic sacrocolpopexy may increase insufflation complications including massive subcutaneous emphysema. The advent of robotic surgery has increased the popularity of laparoscopic sacrocolpopexy. Carbon dioxide insufflation, an essential component of laparoscopy, may rarely cause massive subcutaneous emphysema, which may be coincident with life-threatening situations such as hypercarbia, pneumothorax, and pneumomediastinum. Although the literature contains several reports of massive subcutaneous emphysema after a variety of laparoscopic procedures, we were not able to identify any report of this complication associated with laparoscopic or robotic sacrocolpopexy. Massive subcutaneous emphysema occurred in 3 women after robotic sacrocolpopexy in our practice. The patients had remarkable but reversible physical deformities lasting up to 1 week. A valveless endoscopic dynamic pressure system was used in all 3 of our cases. Our objective is to define the risk of massive subcutaneous emphysema during robotic sacrocolpopexy in light of these cases and discuss probable predisposing factors including the use of valveless endoscopic dynamic pressure trocars.
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Affiliation(s)
- Hatice Celik
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Springfield, MA, USA
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21
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Uyama I, Suda K, Satoh S. Laparoscopic surgery for advanced gastric cancer: current status and future perspectives. J Gastric Cancer 2013; 13:19-25. [PMID: 23610715 PMCID: PMC3627802 DOI: 10.5230/jgc.2013.13.1.19] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 03/06/2013] [Accepted: 03/06/2013] [Indexed: 12/26/2022] Open
Abstract
Laparoscopic gastrectomy has been widely accepted especially in patients with early-stage gastric cancer. However, the safety and oncologic validity of laparoscopic gastrectomy for advanced gastric cancer are still being debated. Since the late 90s', we have been engaged in developing a stable and robust methodology of laparoscopic radical gastrectomy for advanced gastric cancer, and have established laparoscopic distinctive technique for suprapancreatic lymph node dissection, namely the outermost layer-oriented medial approach. In this article, We present the development history of this method, and current status and future perspectives of laparoscopic gastrectomy for advanced gastric cancer based on our experience and a review of the literature.
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Affiliation(s)
- Ichiro Uyama
- Division of Upper Gastrointestinal Tract, Department of Surgery, Fujita Health University, Aichi, Japan
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22
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Hillelsohn JH, Friedlander JI, Bagadiya N, Okhunov Z, Kashan M, Schwartzur M, Kavoussi L. Masked Pneumothorax: Risk of Valveless Trocar Systems. J Urol 2013; 189:955-9. [PMID: 23017523 DOI: 10.1016/j.juro.2012.08.244] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 08/23/2012] [Indexed: 11/24/2022]
Affiliation(s)
- Joel H. Hillelsohn
- Arthur Smith Institute for Urology and Department of Anesthesia (MS), Hofstra North Shore-Long Island School of Medicine, New Hyde Park, New York
| | - Justin I. Friedlander
- Arthur Smith Institute for Urology and Department of Anesthesia (MS), Hofstra North Shore-Long Island School of Medicine, New Hyde Park, New York
| | - Neeti Bagadiya
- Arthur Smith Institute for Urology and Department of Anesthesia (MS), Hofstra North Shore-Long Island School of Medicine, New Hyde Park, New York
| | - Zhamshid Okhunov
- Arthur Smith Institute for Urology and Department of Anesthesia (MS), Hofstra North Shore-Long Island School of Medicine, New Hyde Park, New York
| | - Mahyar Kashan
- Arthur Smith Institute for Urology and Department of Anesthesia (MS), Hofstra North Shore-Long Island School of Medicine, New Hyde Park, New York
| | - Mikhail Schwartzur
- Arthur Smith Institute for Urology and Department of Anesthesia (MS), Hofstra North Shore-Long Island School of Medicine, New Hyde Park, New York
| | - Louis Kavoussi
- Arthur Smith Institute for Urology and Department of Anesthesia (MS), Hofstra North Shore-Long Island School of Medicine, New Hyde Park, New York
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23
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Horstmann M, Horton K, Kurz M, Padevit C, John H. Prospective comparison between the AirSeal® System valve-less Trocar and a standard Versaport™ Plus V2 Trocar in robotic-assisted radical prostatectomy. J Endourol 2013. [PMID: 23186377 DOI: 10.1089/end.2012.0632] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE To prospectively compare the AirSeal® System valve-less Trocar with a standard Versaport™ Plus V2 Trocar as assistant insufflating port in transperitoneal and extraperitoneal robotic-assisted radical prostatectomy (t-RARP/e-RARP). PATIENTS AND METHODS Two consecutive cohorts of patients undergoing RARP using either a 12 mm AirSeal valve-less Trocar (n=19 [14 t-RARP/5 e-RARP]) or a 12 mm Versaport Plus V2 Trocar (n=17 [11 t-RARP/6 e-RARP]) were prospectively evaluated. Age, body mass index, tumor characteristics, and surgical approach were similar in both cohorts. Besides relevant clinical data, episodes of pressure loss (<8 mm Hg), the number of necessary trocar manipulations, the frequency of camera cleaning, and overall carbon dioxide (CO2) consumption were recorded and compared. RESULTS Mean surgical time was 175 minutes in the AirSeal and 166 minutes in the Versaport group (p=0.55). Whereas in the AirSeal group, only one episode of pressure loss <8 mm Hg was observed; this occurred in mean 38 times in the Versaport group (p<0.0001). No trocar manipulations for specimen or needle retrieval were necessary in the AirSeal group in contrast to in mean 15 in the Versaport group (p<0.0001). Otherwise, no appreciable differences regarding overall operating time, blood loss, camera cleaning, or overall CO2 consumption were observed for the present study. Patient CO2 absorption was not evaluated. CONCLUSIONS In the present study, the AirSeal Trocar offered a more stable pneumocavity and facilitated specimen retrieval and needle extraction.
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Affiliation(s)
- Marcus Horstmann
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland.
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24
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Nepple KG, Kallogjeri D, Bhayani SB. Benchtop evaluation of pressure barrier insufflator and standard insufflator systems. Surg Endosc 2012; 27:333-8. [PMID: 22833262 DOI: 10.1007/s00464-012-2434-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 05/31/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous experimental research has reported minimal differences in pressure maintenance between different versions of standard insufflators (SI). However, a recent report identified potential clinical benefits with a valveless pressure barrier insufflator (PBI). We sought to perform a benchtop objective evaluation of SI and PBI systems. METHODS A rigid box system with continuous pressure manometry was used to evaluate a PBI (Surgiquest Airseal) and two SIs (SI1 = Stryker PneumoSure High Flow Insufflator and SI2 = Storz SCB Thermoflator). Pressure maintenance of 15 mmHg was evaluated during experimental conditions of leakage from a 5 mm port site, leakage from a 12 mm port site, and continuous suction. RESULTS With leakage from the 5 mm port site, the PBI maintained pressure of >13 mmHg whereas the pressures dropped moderately with the SI1 (7-13 mmHg) and SI2 insufflators (3-7 mmHg) and did not regain goal pressure until leakage was stopped. With leakage from 12 mm port site, the PBI pressure decreased to 9-11 mmHg, whereas the SI1 and SI2 lost insufflation pressures completely. The PBI maintained pressure of >11 mmHg during continuous suction while the SI1 and SI2 lost pressure entirely, and actually showed negative pressure from air suction into the rigid box system. When evaluated statistically with the mixed model repeated measures ANOVA, the SI1 and SI2 performed similarly while the PBI maintained increased pressure. CONCLUSIONS In the experimental rigid box system, the PBI more successfully maintained pressure in response to leakage and suction than SIs.
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Affiliation(s)
- Kenneth G Nepple
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
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25
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Oh TH. Current status of laparoendoscopic single-site surgery in urologic surgery. Korean J Urol 2012; 53:443-50. [PMID: 22866213 PMCID: PMC3406188 DOI: 10.4111/kju.2012.53.7.443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 06/08/2012] [Indexed: 01/14/2023] Open
Abstract
Since the introduction of laparoscopic surgery, the promise of lower postoperative morbidity and improved cosmesis has been achieved. Laparoendoscopic single-site surgery (LESS) potentially takes this further. Following the first human urological LESS report in 2007, numerous case series have emerged, as well as comparative studies comparing LESS with standard laparoscopy. However, comparative series between conventional laparoscopy and LESS for different procedures suggest a non-inferiority of LESS over standard laparoscopy, but the only objective benefit remains an improved cosmetic outcome. Challenging ergonomics, instrument clashing, lack of true triangulation, and in-line vision are the main concerns with LESS surgery. Various new instruments have been designed, but only experienced laparoscopists and well-selected patients are pivotal for a successful LESS procedure. Robotic-assisted LESS procedures have been performed. The available robotic platform remains bulky, but development of instrumentation and application of robotic technology are expected to define the actual role of these techniques in minimally invasive urologic surgery.
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Affiliation(s)
- Tae Hee Oh
- Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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27
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Leppert JT, Breda A, Harper JD, Schulam PG. Laparoendoscopic single-site porcine nephrectomy using a novel valveless trocar system. J Endourol 2010; 25:119-22. [PMID: 20977374 DOI: 10.1089/end.2010.0199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE The AirSeal™ access system is a novel laparoscopic trocar that uses airflow to create insufflation pressure without the need for a physical seal or valve. By eliminating all valve elements within the lumen of the canula, the port provides a platform that accommodates multiple instruments of any diameter, shape, or combination and is ideally suited for laparoendoscopic single-site surgery (LESS). We present our initial experience with valveless trocars in traditional urologic laparoscopic cases and a porcine LESS nephrectomy series. MATERIALS AND METHODS Nine transperitoneal LESS nephrectomies were performed in a live porcine model using the 27-mm oval valveless trocar. All working instruments were placed through the single port, and the specimen was extracted through the 4-cm port site. RESULTS All cases were completed without technical or operative complications. The porcine single-port nephrectomy (n=9) was successfully performed in a mean operative time of 24 minutes through the single 27-mm oval trocar. This accommodated a 5-mm laparoscope, multiple 5-mm instruments, the Endo GIA stapler, and the 15-mm Endocatch bag without loss of insufflation pressure. Condensation and smudging of the laparoscope were minimized, improving visualization and efficiency. The system allowed for use of suction without significant loss of insufflation pressure. CONCLUSION The initial experience with the AirSeal valveless trocar system in LESS is encouraging. This technology may offer significant benefits over traditional laparoscopic trocars and single -port platforms and appears particularly suited to facilitate LESS.
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Affiliation(s)
- John T Leppert
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095-1738, USA
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Herati AS, Andonian S, Rais-Bahrami S, Atalla MA, Srinivasan AK, Richstone L, Kavoussi LR. Use of the valveless trocar system reduces carbon dioxide absorption during laparoscopy when compared with standard trocars. Urology 2010; 77:1126-32. [PMID: 20888033 DOI: 10.1016/j.urology.2010.06.052] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Revised: 06/19/2010] [Accepted: 06/29/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To prospectively compare a novel type of valveless trocar that creates a curtain of pressurized carbon dioxide [CO(2)] gas (which maintains pneumoperitoneum at a lower gas flow rate) with standard trocars; to quantify the volume of CO(2) used; and to characterize CO(2) elimination during laparoscopic renal surgery. METHODS A total of 51 patients undergoing laparoscopic renal surgery by a single surgeon were prospectively evaluated using either the valveless trocar (n = 26) or standard trocars (n = 25). Patient demographics, operative time, volume of CO(2) gas consumed, CO(2) elimination, perioperative parameters, and postoperative complications were recorded and analyzed. RESULTS Both patient cohorts were comparable in their preoperative demographics, including body mass index, the number of patients with chronic obstructive pulmonary disease, and smoking history. Mean operative time was lower in the valveless trocar cohort (124.1 minutes) compared with the conventional trocar group (145.6 minutes), P = .047. Use of the valveless trocar was associated with a lower volume of intraoperative CO(2) consumed (120.0 ± 82.8 vs 300.6 ± 191.5; P < .001) and reduced CO(2) elimination compared with standard trocar use after the first 16 minutes of insufflation (P < .05). Minimal complications occurred, including 2 cases of subcutaneous emphysema in the valveless trocar group, and 1 case of respiratory acidosis in the conventional trocar group. CONCLUSIONS Use of a valveless trocar significantly reduced CO(2) consumption during transperitoneal laparoscopy. The valveless trocar also demonstrated significantly reduced CO(2) elimination and absorption when compared with the standard trocar.
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Affiliation(s)
- Amin S Herati
- Arthur Smith Institute for Urology, North Shore–Long Island Jewish Health System, Hofstra University School of Medicine, New Hyde Park, New York 11040, USA
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Autorino R, Cadeddu JA, Desai MM, Gettman M, Gill IS, Kavoussi LR, Lima E, Montorsi F, Richstone L, Stolzenburg JU, Kaouk JH. Laparoendoscopic single-site and natural orifice transluminal endoscopic surgery in urology: a critical analysis of the literature. Eur Urol 2010; 59:26-45. [PMID: 20828918 DOI: 10.1016/j.eururo.2010.08.030] [Citation(s) in RCA: 187] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Accepted: 08/17/2010] [Indexed: 02/07/2023]
Abstract
CONTEXT Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have been developed to benefit patients by enabling surgeons to perform scarless surgery. OBJECTIVE To summarize and critically analyze the available evidence on the current status and future perspectives of LESS and NOTES in urology. EVIDENCE ACQUISITION A comprehensive electronic literature search was conducted in June 2010 using the Medline database to identify all publications relating to NOTES and LESS in urology. EVIDENCE SYNTHESIS In urology, NOTES has been completed experimentally via transgastric, transvaginal, transcolonic, and transvesical routes. Initial clinical experience has shown that NOTES urologic surgery using currently available instruments is indeed possible. Nevertheless, because of the immaturity of the instrumentation, early cases have demanded high technical virtuosity. LESS can safely and effectively be performed in a variety of urologic settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low, mostly being small case series or case-control studies from selected centers. Thus, the only objective benefit of LESS remains the improved cosmetic outcome. Prospective, randomized studies are largely awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technology advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics is likely to drive a major paradigm shift in the development of LESS and NOTES. CONCLUSIONS NOTES is still an investigational approach in urology. LESS has proven to be immediately applicable in the clinical field, being safe and feasible in the hands of experienced laparoscopic surgeons. Development of instrumentation and application of robotic technology are expected to define the actual role of these techniques in minimally invasive urologic surgery.
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Affiliation(s)
- Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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Current world literature. Curr Opin Urol 2010; 20:443-51. [PMID: 20679773 DOI: 10.1097/mou.0b013e32833dde0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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