Optimizing working-space in laparoscopy: measuring the effect of mechanical bowel preparation in a porcine model

Vlot, John; Slieker, Juliette; Wijnen, René; Lange, Johan F.; Bax, Klaas N M A

doi:10.1007/s00464-012-2697-2

Cited by 20 publications

(8 citation statements)

References 48 publications

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“…Watkins et al used computed tomography to manually assess thoracic and abdominal volumes created by positive pressure insufflation as well as mechanical lift in dogs. Vlot et al reported pneumoperitoneum volume measurements using CT scans in porcine models, similar to that presented here. Porcine models were investigated during insufflation to define the contributions of subject, anesthetic, and pneumoperitoneum related factors.…”

Section: Discussionsupporting

confidence: 82%

Comparison of Pneumoperitoneum Volumes in Lift Laparoscopy With Variable Lift Locations and Tensile Forces

2015

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Larger isobaric penumoperitoneal volumes are produced with increased tensile force, or with dual lifting at lower force. A caudal lift leads to a small pneumoperitoneal volume but equivalent working space to caudal abdominal structures. Using an umbilical lift with moderate tensile force is preferable, providing good visualization and working space. Caudal lifting may be utilized to access caudal abdominal structures.

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Section: Discussionsupporting

confidence: 82%

Comparison of Pneumoperitoneum Volumes in Lift Laparoscopy With Variable Lift Locations and Tensile Forces

2015

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“…Would MPB result in less impacted bowel and hence better handling? The use of MBP might improve the operative space by cleansing the bowel content [13] . A randomized control trial showed better surgical view in patients with MBP undergoing laparoscopic operations [14] .…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic colorectal resections with and without routine mechanical bowel preparation: A comparative study

Chan

Foo

Poon

et al. 2016

Annals of Medicine &Amp; Surgery

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BackgroundThe benefit of mechanical bowel preparation (MBP) in patients undergoing laparoscopic colorectal resections remains a question. This study aimed to evaluate the effect of omitting MBP on patients undergoing laparoscopic bowel resections.MethodsThe outcomes of patients who underwent elective colorectal resections for cancer of colon and upper rectum without MBP were compared to a retrospective cohort who had MBP.ResultsThere were 97 patients in the No-MBP group and 159 patients in the MBP group. Their mean age, operative risk, tumor size and stage of disease were similar. There were no significant differences in operative time and estimated blood loss. The anastomotic leakage rate was 1.0% in the No-MBP group and 0.6% in the MBP group, (p = 1.00). Wound infection rate were 4.1% and 3.8% in the No-MBP group and the MBP group respectively (p = 1.00). Overall surgical morbidity rate was 11.3% in the No-MBP group and 8.2% in the MBP group (p = 0.40). Conversion rates were 5.2% in the No-MBP group and 6.9% in the MBP group, (p = 0.57).ConclusionThe omission of mechanical bowel preparation does not increase surgical morbidities in patients undergoing laparoscopic bowel resections. It also has no effect on operating time and conversion rate.

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“…Adequate working space is a prerequisite for safe and efficient minimal access surgery. [ 4 ] Several factors influence working space, for example, age and size of the patient, obesity, bowel content, pneumoperitoneum pressure, positioning of the patient, use of systemic neuromuscular blocking agents and ventilation settings. [ 5 ] The working space in infants is limited due to a combination of various factors such as small body habitus, relatively large size of liver and spleen and shallow pelvis.…”

Section: Discussionmentioning

confidence: 99%

Optimising working space for laparoscopic pyeloplasty in infants

Mandelia

Haldar

Siddiqui

et al. 2022

Journal of Minimal Access Surgery

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Aims: This study aimed to test the efficacy of SGPGI protocol to minimise bowel distension and optimise working space for laparoscopic pyeloplasty in infants. Methodology: All infants who underwent laparoscopic pyeloplasty for unilateral pelvi-ureteric junction obstruction (PUJO) between January 2017 and March 2020 were included in the study. The patient cohort was divided into two groups: Group A and B. Group A included patients who underwent routine pre-operative preparation. Group B included patients wherein the SGPGI protocol was used. The key features of the protocol were fasting for 8 h, enemas, inserting a nasogastric tube in the pre-operative period and decompressing the colon on the operation table. Demographic features, pre-operative, intraoperative and post-operative parameters were compared between the two groups. Results: A total of 26 infants with unilateral PUJO underwent laparoscopic pyeloplasty during the study period. Group A included 12 patients and Group B included 14 patients. Both the groups were similar in age, weight and sex distribution. The median surgeon's rating score for suturing conditions was 2 for Group A and 5 for Group B patients ( P > 0.05). The operating time was significantly longer in Group A (196 ± 21 min) as compared to Group B (114 ± 18 min) ( P < 0.05). In Group A, intra-abdominal pressure (IAP) varied between 9 and 14 mmHg (median 12 mmHg), while in Group B, IAP varied between 6 and 9 mmHg (median 8 mmHg) ( P < 0.05). In Group A, in 2/12 cases (16.7%), conversion to an open procedure was necessary because of inadequate working space owing to gross intestinal distension. Two patients in Group A also had intraoperative injuries to adjacent structures due to poor working space. Conclusions: Optimal working space is critical to the performance of advanced laparoscopic surgery like pyeloplasty in infants. SGPGI protocol significantly improves working space, which permits a faster and safer surgery with a lower intra-abdominal working pressure. This protocol is simple, safe and easy to replicate at most centres in our country.

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Optimizing working-space in laparoscopy: measuring the effect of mechanical bowel preparation in a porcine model

Cited by 20 publications

References 48 publications

Comparison of Pneumoperitoneum Volumes in Lift Laparoscopy With Variable Lift Locations and Tensile Forces

Comparison of Pneumoperitoneum Volumes in Lift Laparoscopy With Variable Lift Locations and Tensile Forces

Laparoscopic colorectal resections with and without routine mechanical bowel preparation: A comparative study

Optimising working space for laparoscopic pyeloplasty in infants

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