Insufflation pressure above 25 mm Hg confers no additional benefit over lower pressure insufflation during posterior retroperitoneoscopic adrenalectomy: a retrospective multi-centre propensity score-matched analysis

Abstract

Background Insufflation pressures of or in excess of 25 mm Hg CO 2 are routinely used during posterior retroperitoneoscopic adrenalectomy (PRA) in most centres. A critical analysis of the surgical literature provides limited evidence to support this strategy. Objective To determine whether high pressure (≥ 25 mm Hg) compared with lower pressure (< 25 mm Hg) retroperitoneoscopy reduces operating time and complications. Methods A multi-centre retrospective cohort study was performed using data collected over a period of almost one decade (1st November 2008 until 1st February 2018) from surgical centres in Germany. A total of 1032 patients with benign adrenal tumours were identified. We compared patients undergoing PRA with insufflation pressures of < 25 mm Hg (G20 group) versus ≥ 25 mm Hg (G25 group). A propensity score matching analysis was performed using BMI, tumour size and surgeon's experience as independent variables. The main outcomes were (1) the incidence of perioperative complications and (2) the length of operating time. Results The baseline patient characteristics were similar in both groups, with the exception of tumour size, BMI and surgeon's experience in PRA. After propensity score matching, perioperative outcomes, especially perioperative complications (3.7% vs. 5.5% in G20 and G25, respectively; p = 0.335) and operation duration (47 min vs. 45 min in G20 and G25, respectively; p = 0.673), did not significantly differ between the groups. Conclusion Neither patient safety nor operative success was compromised when PRA was performed with insufflation pressures below 25 mm Hg. Prospective studies are required to determine whether an optimal insufflation pressure exists that maximizes patient safety and minimizes the risks of post-surgical complications. Nevertheless, our results call for a careful re-evaluation of the routine use of high insufflation pressures during PRA. In the absence of prospective data, commencing PRA with lower insufflation pressures, with the option of increasing insufflation pressures to counter intraoperative bleeding or exposition difficulties, may represent a reasonable strategy. Keywords Adrenalectomy • Retroperitoneal space • Minimally invasive surgical procedures • Surgery Abbreviations PRA Posterior retroperitoneoscopic adrenalectomy mm Hg Used for mm Hg CO 2 IQR InterQuartile range SD Standard deviation ASA American Society of Anaesthesiologists PaCO2 Partial pressure of carbon dioxide in the arterial blood Minimally invasive surgery is considered to be the gold standard for the surgical removal of benign functioning and non-functioning adrenal tumours [1-3]. Since its first description [4], minimally invasive adrenal surgery has

Comparative analysis of laparoscopic and open ureteroureterostomy for the treatment of pediatric duplicated kidneys: a clinical efficacy and safety study

“…The establishment of pneumoperitoneum helps minimize vascular bleeding during the surgical process. These factors contribute to the reduced blood loss in laparoscopic surgery ( 24 , 25 ). In addition, laparoscopic surgery, by expanding the field of view and using fine instruments, enables more precise operations, reducing the risk of postoperative urinary leakage and facilitating early removal of the drainage tube.…”