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

Albers, Kim I.; Polat, Fatih; Panhuizen, Ivo F.; Snoeck, M.M.J.; Scheffer, Gert-Jan; Boer, Hans D. de; Warlé, Michiel C.

doi:10.1186/s13063-020-04496-8

Cited by 7 publications

(7 citation statements)

References 38 publications

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“…In most cases, ventilatory adjustments are required, including adding positive end-expiratory pressure (PEEP), increasing ventilation frequency, and raising the oxygen concentration to avoid hypercapnia, hypoxemia and acidosis [ 17 ]. Lastly, operating at a lower insufflation pressure between 8-10mmHg augments ventilatory efforts, improves intraoperative visualization and significantly decreases the degree of postoperative pain experienced [ 20 ]. A randomized controlled study conducted by Albers et al, investigating the effect of low- versus normal-pressure pneumoperitoneum during laparoscopic surgery, demonstrated that operating at a lower insufflation pressure is associated with lower postoperative pain scores, lower incidence of postoperative shoulder tip pain and faster recovery of bowel function [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

A Practical Approach to Total Laparoscopic Hysterectomy in a Morbidly Obese Patient: A Case Report and Literature Review

Bahall¹,

Barry²,

Singh³

2023

Cureus

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Morbid obesity, traditionally considered to be a contraindication to total laparoscopic hysterectomy, is now evolving into an indication. Innovations and advancements in minimally invasive surgical techniques have significantly improved patient morbidity and mortality rates, reduced operational costs, and provided patients with an overall safer surgical experience. Although the laparoscopic approach is associated with several physiologic and technical challenges in the morbidly obese, it is plausible that these patients stand to benefit the most from minimally invasive surgery. This report highlights the methods of preoperative optimization, intraoperative considerations, and postoperative management strategies employed to achieve a successful total laparoscopic hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node dissection in a patient with a BMI of 45kg/m 2 , diagnosed with grade 1 endometrial adenocarcinoma and several obesity-related comorbidities.

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Section: Discussionmentioning

confidence: 99%

A Practical Approach to Total Laparoscopic Hysterectomy in a Morbidly Obese Patient: A Case Report and Literature Review

Bahall¹,

Barry²,

Singh³

2023

Cureus

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“…31 32 This trial was limited to laparoscopic cholecystectomy, but in reviewing the literature we found that the bene cial effects of low-pressure pneumoperitoneum have been exploited to other surgeries. The PAROS 6 and RECOVERY 33 trials are two trials that were made to study the effects of low-pressure pneumoperitoneum in laparoscopic colectomy in regards to pain, hospital stay, and quality of recovery. Their results are not published yet.…”

Section: Discussionmentioning

confidence: 99%

Effect of Low-pressure Pneumoperitoneum on Pain and Inflammation in Laparoscopic Cholecystectomy: A Randomized Controlled Clinical Trial

Rashdan

Daradkeh

Al-Ghazawi

et al. 2023

Preprint

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Objective We aim to assess the effect of low-pressure pneumoperitoneum on post operative pain and ten of the known inflammatory markers. Background The standard of care pneumoperitoneum set pressure in laparoscopic cholecystectomy is set to 12–14 mmHg, but many societies advocate to operate at the lowest pressure allowing adequate exposure of the operative field. Many trials have described the benefits of operating at a low-pressure pneumoperitoneum in terms of lower post operative pain, and better hemodynamic stability. But only few describe the effects on inflammatory markers and cytokines. Methods A prospective, double-blinded, randomised, controlled clinical trial, including patients who underwent elective laparoscopic cholecystectomy. Patients randomised into low-pressure (8–10 mmHg) vs. standard-pressure (12–14 mmHg) with an allocation ratio of 1:1. Perioperative variables were collected and analysed. Registered on ClinicalTrials.gov (NCT05530564/ September 7th, 2022). Results one hundred patients were allocated, 50 patients in each study arm. Low-pressure patients reported lower median pain score 6-hour post operatively (5 vs 6, p-value = 0.021) in comparison with standard-pressure group. Eight out of 10 inflammatory markers demonstrated better results in low-pressure group in comparison with standard-pressure, but the effect was not statistically significant. Total operative time and surgery difficulty was not significantly different between the two groups even in the hands of inexperienced surgeons. Conclusion low-pressure laparoscopic cholecystectomy is associated with less post operative pain and lower rise of inflammatory markers. It is feasible with comparable complications to the standard of care.

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“…The complete methods of the RECOVER study (clinicaltrials.gov NCT03608436) have been described in the published study protocol. 12 In addition, an immunological substudy (RECOVER PLUS, clinicaltrials.gov NCT03572413) was performed in the first 100 patients enrolled at the Canisius Wilhelmina Hospital. Both protocols were approved by the Medical Research Ethics Committee "CMO region Arnhem-Nijmegen" and the competent authority (Central Committee on Research Involving Human Subjects).…”

Section: Methodsmentioning

confidence: 99%

“…The RECOVER study was a multicenter double-blinded randomized controlled trial performed at 3 general teaching hospitals in The Netherlands between October 2018 and March 2021, assessing the effects of LPP facilitated by deep NMB versus SPP and moderate NMB on quality of recovery in patients undergoing colorectal laparoscopic surgery. The complete methods of the RECOVER study (clinicaltrials.gov NCT03608436) have been described in the published study protocol 12. In addition, an immunological substudy (RECOVER PLUS, clinicaltrials.gov NCT03572413) was performed in the first 100 patients enrolled at the Canisius Wilhelmina Hospital.…”

Section: Methodsmentioning

confidence: 99%

Quality of Recovery and Innate Immune Homeostasis in Patients Undergoing Low-pressure Versus Standard-pressure Pneumoperitoneum During Laparoscopic Colorectal Surgery (RECOVER)

et al. 2022

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Objective: To study the effects of intra-abdominal pressure on the quality of recovery and innate cytokine production capacity after laparoscopic colorectal surgery within the enhanced recovery after surgery program. Background: There is increasing evidence for the safety and advantages of low-pressure pneumoperitoneum facilitated by deep neuromuscular blockade (NMB). Nonetheless, there is a weak understanding of the relationship between clinical outcomes, surgical injury, postoperative immune dysfunction, and infectious complications. Methods: Randomized controlled trial of 178 patients treated at standard-pressure pneumoperitoneum (12 mm Hg) with moderate NMB (train-of-four 1-2) or low pressure (8 mm Hg) facilitated by deep NMB (posttetanic count 1-2). The primary outcome was the quality of recovery (Quality of Recovery 40 questionnaire) on a postoperative day 1 (POD1). The primary outcome of the immune substudy (n = 100) was ex vivo tumor necrosis factor α production capacity upon endotoxin stimulation on POD1.Results: Quality of Recovery 40 score on POD1 was significantly higher at 167 versus 159 [mean difference (MD): 8.3 points; 95% confidence interval (CI): 2.5, 14.1; P = 0.005] and the decline in cytokine production capacity was significantly less for tumor necrosis factor α and interleukin-6 (MD: −172 pg/mL; 95% CI: −316, −27; P = 0.021 and MD: −1282 pg/ mL; 95% CI: −2505, −59; P = 0.040, respectively) for patients operated at low pressure. Low pressure was associated with reduced surgical site hypoxia and inflammation markers and circulating damage-associated molecular patterns, with a less impaired early postoperative ex vivo cytokine production capacity. At low pressure, patients reported lower acute pain scores and developed significantly less 30-day infectious complications. Conclusions: Low intra-abdominal pressure during laparoscopic colorectal surgery is safe, improves the postoperative quality of recovery and preserves innate immune homeostasis, and forms a valuable addition to future enhanced recovery after surgery programs.

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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

Cited by 7 publications

References 38 publications

A Practical Approach to Total Laparoscopic Hysterectomy in a Morbidly Obese Patient: A Case Report and Literature Review

A Practical Approach to Total Laparoscopic Hysterectomy in a Morbidly Obese Patient: A Case Report and Literature Review

Effect of Low-pressure Pneumoperitoneum on Pain and Inflammation in Laparoscopic Cholecystectomy: A Randomized Controlled Clinical Trial

Quality of Recovery and Innate Immune Homeostasis in Patients Undergoing Low-pressure Versus Standard-pressure Pneumoperitoneum During Laparoscopic Colorectal Surgery (RECOVER)

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