Oscar Diaz-CambroneroBlas Flor LorenteGuido MazzinariMaria Vila MontañesNuria García GregorioDaniel Robles HernandezLuis Enrique Olmedilla ArnalMaria Pilar Argente NavarroMarcus J. SchultzCarlos L. ErrandoSalvador PousCristina BallesterMatteo FrassonAlvaro García-GraneroCarlos Cerdán SantacruzEduardo García-GraneroLuis Sanchez GuillenAnabel Marqués MaríDavid Casado RodrigoJoan Gibert GerezRebeca Cosa RodríguezMª de los Desamparados Moya SanzMarcos Rodriguez MartínJaime Zorrilla OrtúzarJosé María Pérez-PeñaMaria Jose Alberola EstellésBegoña Ayas MonteroSalome Matoses JaenSandra VerdeguerMichiel WarléDavid Cuesta FrauHospital General Universitario Gregorio MarañonHospital Universitari i Politècnic La FeHospital General Universitario de ValenciaMahidol UniversityHospital General de CastellonAmsterdam UMC - University of AmsterdamHospital de Manises2020-01-272020-01-272019-01-15Surgical Endoscopy. Vol.33, No.1 (2019), 252-26014322218093027942-s2.0-85049118792https://repository.li.mahidol.ac.th/handle/20.500.14594/51964© 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).Mahidol UniversityMedicineArticleSCOPUS10.1007/s00464-018-6305-y