Valveless Trocar Versus Standard Pneumoperitoneum Insufflation System in Minimally Invasive Surgery: Impact on Postoperative Pain. A Systematic Review and Meta-Analysis

Claroni, Claudia; Morettini, Lucio; Tola, Gabriele; Covotta, Marco; Forastiere, Ester; Torregiani, Giulia

doi:10.1089/lap.2022.0022

Cited by 6 publications

(2 citation statements)

References 29 publications

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“…When the intra-abdominal pressure exceeds the appropriate intraperitoneal pressure, the intraperitoneal gas leaks out through the air seal barrier to keep the intraperitoneal pressure within the appropriate range(1). The AirSeal system reportedly helps to reduce shoulder pain due to excessive intraperitoneal pressure during laparoscopic surgery compared with the conventional insu ator, which has a mechanical valve on the access port (2)(3)(4). Moreover, this system shortens the operative time because it constantly maintains a large intra-abdominal space for surgical procedures (5).…”

Section: Introductionmentioning

confidence: 99%

Effect of heating insufflation tube of AirSeal system on laparoscopic surgery

Yoshimatsu

Sahara

Ohno

et al. 2023

Preprint

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The AirSeal system (CONMED, NY, USA) can outstandingly keep pneumoperitoneum stable. However, water droplets form on the access port, impairing the performance of comfortable surgical procedures because of the resultant wet surgical field. This study was performed to clarify the mechanism of water droplet formation and to prevent it. Condensation was observed on the AirSeal system. A heater was wrapped around the tri-lumen tube, and the heating effect was assessed. The simulator experiments revealed that condensation formed in the tri-lumen tube and on the wall of the access port. The accumulated weight of the condensation on the wall of the access port was 41.6 g in the Heated group, 138.2 g in the Control group, and 479.4 g in the Cooled group. In the clinical assessment, the accumulated volume of the condensation attached to the inside wall was significantly smaller in the Heated group than in the Unheated group (111.7 g vs. 332.9 g, respectively). We clarified that the volume of condensation attached to the wall of the access port depended on the temperature of the tri-lumen tube. The clinical study revealed that the condensation on the access port was reduced by heating the tri-lumen tube. The development of a novel heating device for the insufflation tube would be effective and useful.

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Section: Introductionmentioning

confidence: 99%

Effect of heating insufflation tube of AirSeal system on laparoscopic surgery

Yoshimatsu

Sahara

Ohno

et al. 2023

Preprint

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“…Valveless systems inject CO 2 at high flows through the working channel of the trocar to form the pressure barrier that maintains the pneumoperitoneum. The pneumoperitoneum pressure is measured at the distal trocar tip, while gas at the proximal side is taken up, filtered, and re-injected through the working channel [ 4 ].…”

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confidence: 99%

Escape of surgical smoke particles, comparing conventional and valveless trocar systems

Robertson,

Sterke,

van Weteringen

et al. 2023

Surg Endosc

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Background During minimal access surgery, surgical smoke is produced which can potentially be inhaled by the surgical team, leading to several health risks. This smoke can escape from the abdominal cavity into the operating room due to trocar leakage. The trocars and insufflator that are used during surgery influence gas leakage. Therefore, this study compares particle escape from a valveless (Conmed AirSeal iFS), and a conventional (Karl Storz Endoflator) system. Materials and methods Using an in vitro model, a conventional and a valveless trocar system were compared. A protocol that simulated various surgical phases was defined to assess the surgical conditions and particle leakage. Insufflation pressures and instrument diameters were varied as these are known to affect gas leakage. Results The conventional trocar leaked during two distinct phases. Removal of the obturator caused a sudden release of particles. During instrument insertion, an average of 211 (IQR 111) particles per second escaped when using the 5 mm diameter instrument. With the 10 mm instrument, 50 (IQR 13) particles per second were measured. With the conventional trocar, a higher abdominal pressure increased particle leakage. The valveless trocar demonstrated a continuously high particle release during all phases. After the obturator was removed, particle escape increased sharply. Particle escape decreased to 1276 (IQR 580) particles per second for the 5 mm instrument insertion, and 1084 (IQR 630) particles per second for 10 mm instrument insertion. With the valveless trocar system, a higher insufflation pressure lowered particle escape. Conclusions This study shows that a valveless trocar system releases more particles into the operating room environment than a conventional trocar. During instrument insertion, the leakage through the valveless system is 6 to 20 times higher than the conventional system. With a valveless trocar, leakage decreases with increasing pressure. With both trocar types leakage depends on instrument diameter.

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