Influence of pneumoperitoneum pressure on surgical field during robotic and laparoscopic surgery: a comparative study

Angioli, Roberto; Terranova, Corrado; Plotti, Francesco; Cafà, Ester Valentina; Gennari, P; Ricciardi, Roberto; Aloisi, Alessia; Miranda, Andrea; Montera, Roberto; Nardone, Carlo De Cicco

doi:10.1007/s00404-014-3494-z

Cited by 31 publications

(23 citation statements)

References 16 publications

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“…The use of low intra-abdominal insufflation pressure decreases postoperative pain in laparoscopic cholecystectomy [ 2 , 3 ], and also evidence exists that postoperative pain is decreased when low-pressure pneumoperitoneum (PNP) is used during LDN [ 4 ]. However, the use of low-pressure PNP can impair surgical field visualization [ 5 , 6 ]. To optimize the quality of the surgical conditions, Madsen et al [ 7 ] used a deep neuromuscular block (NMB) to enhance surgical space, measured as the distance from the sacral promontory to the trocar.…”

Section: Introductionmentioning

confidence: 99%

Quality of Recovery After Low‐Pressure Laparoscopic Donor Nephrectomy Facilitated by Deep Neuromuscular Blockade: A Randomized Controlled Study

et al. 2017

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BackgroundThe use of low intra-abdominal pressure (<10 mmHg) reduces postoperative pain scores after laparoscopic surgery. ObjectiveTo investigate whether low-pressure pneumoperitoneum with deep neuromuscular blockade improves the quality of recovery after laparoscopic donor nephrectomy (LDN).Design, setting and participantsIn a single-center randomized controlled trial, 64 live kidney donors were randomly assigned to 6 or 12 mmHg insufflation pressure. A deep neuromuscular block was used in both groups. Surgical conditions were rated by the five-point Leiden-surgical rating scale (L-SRS), ranging from 5 (optimal) to 1 (extremely poor) conditions. If the L-SRS was insufficient, the pressure was increased stepwise. Main outcome measureThe primary outcome measure was the overall score on the quality of recovery-40 (QOR-40) questionnaire at postoperative day 1.ResultsThe difference in the QOR-40 scores on day 1 between the low- and standard-pressure group was not significant (p = .06). Also the overall pain scores and analgesic consumption did not differ. Eight procedures (24%), initially started with low pressure, were converted to a standard pressure (≥10 mmHg). A L-SRS score of 5 was significantly more prevalent in the standard pressure as compared to the low-pressure group at 30 min after insufflation (p < .01).ConclusionsLow-pressure pneumoperitoneum facilitated by deep neuromuscular blockade during LDN does not reduce postoperative pain scores nor improve the quality of recovery in the early postoperative phase. The question whether the use of deep neuromuscular blockade during laparoscopic surgery reduces postoperative pain scores independent of the intra-abdominal pressure should be pursued in future studies.Trial registrationThe trial was registered at clinicaltrial.gov before the start of the trial (NCT02146417).

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Section: Introductionmentioning

confidence: 99%

Quality of Recovery After Low‐Pressure Laparoscopic Donor Nephrectomy Facilitated by Deep Neuromuscular Blockade: A Randomized Controlled Study

et al. 2017

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“…Also, the added value of RAS to both the issue of gas leakage and of pulmonary stress is that CO 2 pressure can be minimized. Whereas pressure for optimal vison at conventional laparoscopy should be at between 10-15 mmHg, robotic vision remains stable and optimal up to 5 mmHg [18].…”

Section: Pro's and Con's Of Rasmentioning

confidence: 99%

Robot assisted surgery during the COVID-19 pandemic, especially for gynecological cancer: a statement of the Society of European Robotic Gynaecological Surgery (SERGS)

2020

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All surgery performed in an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, irrespective of the known or suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) status of the patient, should be regarded as high risk and protection of the surgical team at the bedside should be at the highest level. Robot assisted surgery (RAS) may help to reduce hospital stay for patients that urgently need complex-oncological-surgery, thus making room for COVID-19 patients. In comparison to open or conventional laparoscopic surgery, RAS potentially reduces not only contamination with body fluids and surgical gasses of the surgical area but also the number of directly exposed medical staff. A prerequisite is that general surgical precautions under COVID-19 circumstances must be taken, with the addition of prevention of gas leakage:• Use highest protection level III for bedside assistant, but level II for console surgeon.• Reduce the number of staff at the operation room.• Ensure safe and effective gas evacuation.• Reduce the intra-abdominal pressure to 8 mmHg or below.• Minimize electrocautery power and avoid use of ultrasonic sealing devices.• Surgeons should avoid contact outside theater (both in and out of the hospital).

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“…Viral load might potentially even be higher in operating fields close to the lungs, especially because COVID-19 lesions are mostly seen at the basal and peripheral parts of the lungs [7]. Insufflation pressures should, therefore, be reduced to the lowest level possible without compromising the surgical field exposure; research has demonstrated that robotic vision remains stable and optimal up to 5 mmHg [8]. Care should also be taken to prevent sudden release of trocar valves or non-air-tight change of instruments.…”

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confidence: 99%

Cardiothoracic robotic assisted surgery in times of COVID-19

et al. 2020

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The coronavirus disease 2019 pandemic poses an immense threat to healthcare systems worldwide. At a time when elective surgeries are being suspended and questions are being raised about how the remaining procedures on COVID-19 positive patients can be performed safely, it is important to consider the potential role of robotic assisted surgery within the current pandemic. Recently, several robotic assisted surgery societies have issued their recommendations. To date, however, no specific recommendations are available for cardiothoracic robotic assisted surgery in COVID-19 positive patients. Here, we discuss the potential risks, benefits, and preventive measures that need to be taken into account when considering robotic assisted surgery for cardiothoracic indications in patients with confirmed COVID-19. It is suggested that robotic assisted surgery might have various advantages such as early recovery after surgery, shorter hospital stay, and reduced loss of blood and fluids as well as smaller incisions. However, electrosurgical and ultrasonic devices, as well as CO2 insufflation should be managed with caution to prevent the risk of aerosolization of viral particles.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Influence of pneumoperitoneum pressure on surgical field during robotic and laparoscopic surgery: a comparative study

Cited by 31 publications

References 16 publications

Quality of Recovery After Low‐Pressure Laparoscopic Donor Nephrectomy Facilitated by Deep Neuromuscular Blockade: A Randomized Controlled Study

Quality of Recovery After Low‐Pressure Laparoscopic Donor Nephrectomy Facilitated by Deep Neuromuscular Blockade: A Randomized Controlled Study

Robot assisted surgery during the COVID-19 pandemic, especially for gynecological cancer: a statement of the Society of European Robotic Gynaecological Surgery (SERGS)

Cardiothoracic robotic assisted surgery in times of COVID-19

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