Instrument usage in laparoscopic gynecologic surgery: a prospective clinical trial

Stotz, L; Joukhadar, Ralf; Hamza, A; Thangarajah, Fabinshy; Bardens, David; Juhasz-Böss, Ingolf; Solomayer, Erich‐Franz; Radosa, MP; Radosa, Julia Caroline

doi:10.1007/s00404-018-4867-5

Cited by 13 publications

(8 citation statements)

References 17 publications

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“…The work by Stotz et al [ 1 ] describes the type and usage of instruments and trocars during a median of 103 gynaecological laparoscopic interventions. This data can be used to estimate leakage during a hypothetical intervention to add perspective to the individual measurement results of this study.…”

Section: Discussionmentioning

confidence: 99%

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Characterisation of trocar associated gas leaks during laparoscopic surgery

et al. 2021

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Background During laparoscopy, the abdominal cavity is insufflated with carbon dioxide (CO2) that could become contaminated with viruses and surgical smoke. Medical staff is potentially exposed when this gas leaks into the operating room through the instruments and past trocar valves. No detailed studies currently exist that have quantified these leakage pathways. Therefore, the goal of this study was to quantify the gas leakages through trocars and instruments, during minimally invasive procedures. Methods A model of the surgical environment was created, consisting of a rigid container with an interface for airtight clamping of laparoscopic equipment such as trocars and surgical instruments. The model was insufflated to 15 mm Hg using a pressure generator and a pneumotachograph measured the equipment gas leak. A protocol of several use cases was designed to simulate the motions and forces the surgeon exerts on the trocar during surgery. Results Twenty-three individual trocars and twenty-six laparoscopic instruments were measured for leakage under the different conditions of the protocol. Trocar leakages varied between 0 L/min and more than 30 L/min, the instruments revealed a range of leakages between 0 L/min and 5.5 L/min. The results showed that leakage performance varied widely between trocars and instruments and that the performance and location of the valves influenced trocar leakage. Conclusions We propose trocar redesigns to overcome specific causes of gas leaks. Moreover, an international testing standard for CO2 leakage for all new trocars and instruments is needed so surgical teams can avoid this potential health hazard when selecting new equipment.

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Section: Discussionmentioning

confidence: 99%

“…In clinical practice, a perfect gas seal is difficult to achieve, with minor leaks of CO 2 through the incision, the trocars and the surgical instruments. In certain procedures with higher pressures, longer operating times, or frequent instrument changes this can result in the leakage of several hundred litres of gas into the operating theatre [ 1 ].…”

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confidence: 99%

Characterisation of trocar associated gas leaks during laparoscopic surgery

et al. 2021

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“…Early stage studies have shown prominent attention given to gas leakage through the trocar (port) [2,35]. And no data currently exists in literature that attempts to quantify gas leakage during instrument use and exchange, despite the fact the literature shows that such events are overly abundant in every laparoscopic procedure [36][37][38]. More work is needed to better understand the level of risk of clinician safety in today's OR to guide us to a safer OR of the future around this rising issue, brought to the forefront of people's minds during this global COVID-19 pandemic.…”

Section: Need For More Research To Accurately Quantify the Problemmentioning

confidence: 99%

“…The Instrument Full Insertion/Removal scenario was used to simulate an instrument exchange or other such removal and/or insertion event, which is commonly experienced during laparoscopy for each and every case. For example, scope removals are often performed to clean the lens, and instruments are commonly removed to achieve access through a different port or to exchange them out for a new instrument [36,37,[40][41][42][43]. Each instrument-port configuration also helped to represent a few different levels of such combinations seen in today's OR.…”

Section: Test Procedures For Each Use Case Scenariomentioning

confidence: 99%

Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery

Uecker

Fagerberg²,

Ahmad³

et al. 2020

Surg Endosc

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Background Viral particles have been shown to aerosolize into insufflated gas during laparoscopic surgery. In the operating room, this potentially exposes personnel to aerosolized viruses as well as carcinogens. In light of circumstances surrounding COVID-19 and a concern for the safety of healthcare professionals, our study seeks to quantify the volumes of gas leaked from dynamic interactions between laparoscopic instruments and the trocar port to better understand potential exposure to surgically aerosolized particles. Methods A custom setup was constructed to simulate an insufflated laparoscopic surgical cavity. Two surgical instrument use scenarios were examined to observe and quantify opportunities for insufflation gas leakage. Both scenarios considered multiple configurations of instrument and trocar port sizes/dimensions: (1) the full insertion and full removal of a laparoscopic instrument from the port and (2) the movement of the scope within the port, recognized as "dynamic interaction", which occurs nearly 100% of the time over the course of any procedure. Results For a 5 mm instrument in a 5 mm trocar, the average volume of gas leaked during dynamic interaction and full insertion/removal scenarios were 43.67 and 25.97 mL of gas, respectively. Volume of gas leaked for a 5 mm instrument in a 12 mm port averaged 41.32 mL and 29.47 for dynamic interaction vs. instrument insertion and removal. Similar patterns were shown with a 10 mm instrument in 12 mm port, with 55.68 mL for the dynamic interaction and 58.59 for the instrument insertion/removal. Conclusions Dynamic interactions and insertion/removal events between laparoscopic instruments and ports appear to contribute to consistent leakage of insufflated gas into the OR. Any measures possible taken to reduce OR gas leakage should be considered in light of the current COVID-19 pandemic. Minimizing laparoscope and instrument removal and replacement would be one strategy to mitigate gas leakage during laparoscopic surgery.

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“…Gynecological laparoscopic surgery has been progressively and successfully introduced into practice as, this minimally invasive surgery is associated with low morbidity, less postoperative pain, and improved cosmetics [4]. In addition to diagnostic indications, operative procedures at the time of laparoscopy proved to enhance both spontaneous and assisted conception rates [5].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Laparoscopy and Hysteroscopy to Optimize the Outcome of Assisted Reproductive Technology

Emam

Elshwaikh

Aglan

et al. 2021

JAMMR

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Background: Identifying the cause of infertility is complex and often reveals overlapping etiologies. Because of the valuable characteristics of hysteroscopy, it has been deemed a promising surgical intervention to improve in vitro fertilization (IVF) outcomes. The present study aimed to evaluate the role and effectiveness of combined laparoscopy and hysteroscopy in the assessment of uterine pathologies in infertile women with recurrent implantation failure (RIF) after IVF, and explore whether removal of such pathologies increased the rate of pregnancy in those women. Methods: This prospective observational cohort study included 40 infertile patients presented with either primary or secondary infertility after repeated IVF/ intracytoplasmic sperm injection (ICSI) failure. Participants were selected from Endoscopy and Assisted Reproductive units in Obstetrics and Gynecology department at Tanta University Hospital. Results: There was a statistically significant higher rate of successful cases in the abnormal hysteroscopic findings group. There was no statistically significant difference between normal and abnormal laparoscopic findings groups as regard successful ICSI procedure. Conclusions: Hysteroscopy is recommended to be a routine diagnostic and therapeutic tool in any case with RIF or recurrent IVF/ICSI failures before a new attempt as it increases the success rate. We can’t recommend routine laparoscopy in any case with RIF or recurrent IVF/ICSI failures.

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Instrument usage in laparoscopic gynecologic surgery: a prospective clinical trial

Abstract: We analyzed the current instrument usage in laparoscopic gynecological surgeries. The results of our standardized investigation suggest ways to reduce the time required for surgery and provide starting points for the standardization of the work routine.

Cited by 13 publications

References 17 publications

Characterisation of trocar associated gas leaks during laparoscopic surgery

Characterisation of trocar associated gas leaks during laparoscopic surgery

Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery

Effectiveness of Laparoscopy and Hysteroscopy to Optimize the Outcome of Assisted Reproductive Technology

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