Small-Incision Laparoscopy-Assisted Surgery Under Abdominal Cavity Irrigation in a Porcine Model

Abstract

Background: Laparoscopic and robot-assisted surgeries are performed under carbon dioxide insufflation. Switching from gas to an isotonic irrigant introduces several benefits and avoids some adverse effects of gas insufflation. We developed an irrigating device and apparatus designed for single-incision laparoscopic surgery and tested its advantages and drawbacks during surgery in a porcine model.Materials and Methods: Six pigs underwent surgical procedures under general anesthesia. A 30-cm extracorporeal cistern was placed over a 5–6-cm abdominal incision. The abdomen was irrigated with warm saline that was drained via a suction tube placed near the surgical field and continuously recirculated through a closed circuit equipped with a hemodialyzer as a filter. Irrigant samples from two pigs were cultured to check for bacterial and fungal contamination. Body weight was measured before and after surgery in four pigs that had not received treatments affecting hemodynamics or causing diuresis.Results: One-way flow of irrigant ensured laparoscopic vision by rinsing blood from the surgical field. Through a retroperitoneal approach, cystoprostatectomy was successfully performed in three pigs, nephrectomy in two, renal excision in two, and partial nephrectomy in one, under simultaneous ultrasonographic monitoring. Through a transperitoneal approach, liver excision and hemostasis with a bipolar sealing device were performed in three pigs, and bladder pedicle excision was performed in one pig. Bacterial and fungal contamination of the irrigant was observed on the draining side of the circuit, but the filter captured the contaminants. Body weight increased by a median of 2.1% (range, 1.2–4.4%) of initial weight after 3–5 hours of irrigation.Conclusions: Surgery under irrigation is feasible and practical when performed via a cistern through a small abdominal incision. This method is advantageous, especially in the enabling of continuous and free-angle ultrasound observation of parenchymal organs. Adverse effects of abdominal irrigation need further assessment before use in humans.

Development of detection method for automatic hemostasis using machine learning with abdominal cavity irrigation

“…Studies on the detection of bleeding in endoscopic images have been based on the color feature descriptor, texture feature descriptor, and edge feature descript to in the field of diagnosing using wireless capsule endoscopy. [7][8][9][10][11][12][13] In a previous study aimed at assisting the hemostasis procedure, the authors used a bleeding region detection method in endoscopic surgery with a focus on detection accuracy and calculation cost of a linear support vector machine (SVM) based on the color feature descriptor. 14,15 However, previous studies did not attempt to detect the hemostatic region.…”

“…In this paper, we focused on a new technique performed in liquid (water-filled laparoendoscopic surgery, WaFLES), because endoscopic images using liquid are clearer than those using gas. 7 This liquid surgical technique is majorly used in the field of urology owing to its high safety and low invasiveness. 8 Using the irrigation liquid, the region was cleaned, so it was possible to monitor the organs, bleeding sites, and hemostatic regions.…”

Importance of Hydrostatic Pressure and Irrigation for Hemostasis in Neuroendoscopic Surgery

“… 1 , 2) Irrigation fluids can enlarge, without a need for a brain retractor, the ventricles or excretory cavities that often shrink during the later stages of an operation owing to normal brain pressure. Under wet conditions, surgeons can easily identify the residual tumors behind the ventricle walls or within a cyst; such conditions have been commonly utilized in urology and orthopedic surgeries such as cystoscopy and arthroscopy, and studies report increased efficiency, 3) better visualization, 4 , 5) and minimal blood loss 6) with the use of wet conditions.…”