Low-pressure pneumoperitoneum with abdominal wall lift in laparoscopic total mesorectal excision for rectal cancer: Initial experience

Abstract

AIMTo evaluate the safety and feasibility of a new technology combining low-pressure pneumoperitoneum (LPP) and abdominal wall lift (AWL) in laparoscopic total mesorectal excision (TME) for rectal cancer.METHODSFrom November 2015 to July 2017, 26 patients underwent laparoscopic TME for rectal cancer using LPP (6-8 mmHg) with subcutaneous AWL in Qilu Hospital of Shandong University, Jinan, China. Clinical data regarding patients’ demographics, intraoperative monitoring indices, operation-related indices and pathological outcomes were prospectively collected.RESULTSLaparoscopic TME was performed in 26 cases (14 anterior resection and 12 abdominoperineal resection) successfully, without conversion to open or laparoscopic surgery with standard-pressure pneumoperitoneum. Intraoperative monitoring showed stable heart rate, blood pressure and paw airway pressure. The mean operative time was 194.29 ± 41.27 min (range: 125-270 min) and 200.41 ± 20.56 min (range: 170-230 min) for anterior resection and abdominoperineal resection, respectively. The mean number of lymph nodes harvested was 16.71 ± 5.06 (range: 7-27). There was no positive circumferential or distal resection margin. No local recurrence was observed during a median follow-up period of 11.96 ± 5.55 mo (range: 5-23 mo).CONCLUSIONLPP combined with AWL is safe and feasible for laparoscopic TME. The technique can provide satisfactory exposure of the operative field and stable operative monitoring indices.

Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery

“…Several studies 12,30,31 have shown a low pneumoperitoneum pressure to be feasible during laparoscopic surgery. However, none of them assessed the effects on quality of recovery.…”

The effect of low- versus normal-pressure pneumoperitoneum during laparoscopic colorectal surgery on the early quality of recovery with perioperative care according to the enhanced recovery principles (RECOVER): study protocol for a randomized controlled study

“…There is increasing evidence for the use of lower insufflation pressures during laparoscopic surgery [1][2][3][4][5]. Consensus guidelines recommend using the lowest intraabdominal pressure with an adequate view of the surgical field [6,7].…”

Effect of pneumoperitoneum pressure and the depth of neuromuscular block on renal function in patients with diabetes undergoing laparoscopic pelvic surgery: study protocol for a double-blinded 2 × 2 factorial randomized controlled trial

“…Low-pressure pneumoperitoneum (LPP, 7-10 mmHg) is recommended to minimize the ischemic organ injury caused by standard-pressure pneumoperitoneum (SPP, 12-15 mmHg) [27]. LPP has been successfully used in a series of abdominal and pelvic surgeries, such as laparoscopic hysterectomy, cholecystectomy, and adrenalectomy [28][29][30][31]. However, LPP compromises the working space and surgical field, leading to prolonged surgical durations [32].…”