Publication:
A multifaceted individualized pneumoperitoneum strategy for laparoscopic colorectal surgery: a multicenter observational feasibility study

Issued Date

2019-01-15

Resource Type

Article

ISSN

14322218
09302794

DOI

10.1007/s00464-018-6305-y

Other identifier(s)

2-s2.0-85049118792

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

Surgical Endoscopy. Vol.33, No.1 (2019), 252-260

Suggested Citation

Oscar Diaz-Cambronero, Blas Flor Lorente, Guido Mazzinari, Maria Vila Montañes, Nuria García Gregorio, Daniel Robles Hernandez, Luis Enrique Olmedilla Arnal, Maria Pilar Argente Navarro, Marcus J. Schultz, Carlos L. Errando, Salvador Pous, Cristina Ballester, Matteo Frasson, Alvaro García-Granero, Carlos Cerdán Santacruz, Eduardo García-Granero, Luis Sanchez Guillen, Anabel Marqués Marí, David Casado Rodrigo, Joan Gibert Gerez, Rebeca Cosa Rodríguez, Mª de los Desamparados Moya Sanz, Marcos Rodriguez Martín, Jaime Zorrilla Ortúzar, José María Pérez-Peña, Maria Jose Alberola Estellés, Begoña Ayas Montero, Salome Matoses Jaen, Sandra Verdeguer, Michiel Warlé, David Cuesta Frau A multifaceted individualized pneumoperitoneum strategy for laparoscopic colorectal surgery: a multicenter observational feasibility study. Surgical Endoscopy. Vol.33, No.1 (2019), 252-260. doi:10.1007/s00464-018-6305-y Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/51964

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Title

A multifaceted individualized pneumoperitoneum strategy for laparoscopic colorectal surgery: a multicenter observational feasibility study

Author(s)

Oscar Diaz-Cambronero
 Blas Flor Lorente
 Guido Mazzinari
 Maria Vila Montañes
 Nuria García Gregorio
 Daniel Robles Hernandez
 Luis Enrique Olmedilla Arnal
 Maria Pilar Argente Navarro
 Marcus J. Schultz
 Carlos L. Errando
 Salvador Pous
 Cristina Ballester
 Matteo Frasson
 Alvaro García-Granero
 Carlos Cerdán Santacruz
 Eduardo García-Granero
 Luis Sanchez Guillen
 Anabel Marqués Marí
 David Casado Rodrigo
 Joan Gibert Gerez
 Rebeca Cosa Rodríguez
 Mª de los Desamparados Moya Sanz
 Marcos Rodriguez Martín
 Jaime Zorrilla Ortúzar
 José María Pérez-Peña
 Maria Jose Alberola Estellés
 Begoña Ayas Montero
 Salome Matoses Jaen
 Sandra Verdeguer
 Michiel Warlé
 David Cuesta Frau

Other Contributor(s)

Hospital General Universitario Gregorio Marañon
 Hospital Universitari i Politècnic La Fe
 Hospital General Universitario de Valencia
 Mahidol University
 Hospital General de Castellon
 Amsterdam UMC - University of Amsterdam
 Hospital de Manises

Abstract

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. Background: While guidelines for laparoscopic abdominal surgery advise using the lowest possible intra-abdominal pressure, commonly a standard pressure is used. We evaluated the feasibility of a predefined multifaceted individualized pneumoperitoneum strategy aiming at the lowest possible intra-abdominal pressure during laparoscopic colorectal surgery. Methods: Multicenter prospective study in patients scheduled for laparoscopic colorectal surgery. The strategy consisted of ventilation with low tidal volume, a modified lithotomy position, deep neuromuscular blockade, pre-stretching of the abdominal wall, and individualized intra-abdominal pressure titration; the effect was blindly evaluated by the surgeon. The primary endpoint was the proportion of surgical procedures completed at each individualized intra-abdominal pressure level. Secondary endpoints were the respiratory system driving pressure, and the estimated volume of insufflated CO 2 gas needed to perform the surgical procedure. Results: Ninety-two patients were enrolled in the study. Fourteen cases were converted to open surgery for reasons not related to the strategy. The intervention was feasible in all patients and well-accepted by all surgeons. In 61 out of 78 patients (78%), surgery was performed and completed at the lowest possible IAP, 8 mmHg. In 17 patients, IAP was raised up to 12 mmHg. The relationship between IAP and driving pressure was almost linear. The mean estimated intra-abdominal CO 2 volume at which surgery was performed was 3.2 L. Conclusion: A multifaceted individualized pneumoperitoneum strategy during laparoscopic colorectal surgery was feasible and resulted in an adequate working space in most patients at lower intra-abdominal pressure and lower respiratory driving pressure. ClinicalTrials.gov (Trial Identifier: NCT03000465).

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/51964

Collections

Scopus 2019