A multifaceted individualized pneumoperitoneum strategy for laparoscopic colorectal surgery: a multicenter observational feasibility study
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While guidelines for laparoscopic abdominal surgery advise using the lowest possible intra-abdominal pressure, commonly a standard pressure is used. We evaluated the feasibility of a predefined multifaceted individualized pneumoperitoneum strategy aiming at the lowest possible intra-abdominal pressure during laparoscopic colorectal surgery.
Multicenter prospective study in patients scheduled for laparoscopic colorectal surgery. The strategy consisted of ventilation with low tidal volume, a modified lithotomy position, deep neuromuscular blockade, pre-stretching of the abdominal wall, and individualized intra-abdominal pressure titration; the effect was blindly evaluated by the surgeon. The primary endpoint was the proportion of surgical procedures completed at each individualized intra-abdominal pressure level. Secondary endpoints were the respiratory system driving pressure, and the estimated volume of insufflated CO2 gas needed to perform the surgical procedure.
Ninety-two patients were enrolled in the study. Fourteen cases were converted to open surgery for reasons not related to the strategy. The intervention was feasible in all patients and well-accepted by all surgeons. In 61 out of 78 patients (78%), surgery was performed and completed at the lowest possible IAP, 8 mmHg. In 17 patients, IAP was raised up to 12 mmHg. The relationship between IAP and driving pressure was almost linear. The mean estimated intra-abdominal CO2 volume at which surgery was performed was 3.2 L.
A multifaceted individualized pneumoperitoneum strategy during laparoscopic colorectal surgery was feasible and resulted in an adequate working space in most patients at lower intra-abdominal pressure and lower respiratory driving pressure.
ClinicalTrials.gov (Trial Identifier: NCT03000465).
KeywordsLaparoscopy Colorectal surgery Neuromuscular blockade
We acknowledge the support of surgery, anesthesia, and administrative staff at the Hospital Universitario y Politecnico La Fe in Valencia, the Hospital General de Castellon in Castellon, and the Hospital Universitario Gregorio Marañon in Madrid, Spain, during this study and a special mention to David Hervás from Data Science and Biostatistics IISLaFe for the assistance with the data analysis.
IPPColLapSe study collaborators group members: Salvador Pous Ph.D. (email@example.com), Cristina Ballester Ph.D. (firstname.lastname@example.org), Matteo Frasson Ph.D. (email@example.com), Alvaro García-Granero Ph.D. (firstname.lastname@example.org), Carlos Cerdán Santacruz M.D. (email@example.com), Eduardo García-Granero Ph.D. (firstname.lastname@example.org), Luis Sanchez Guillen M.D. (email@example.com), Anabel Marqués Marí Ph.D. (firstname.lastname@example.org), David Casado Rodrigo M.D. (email@example.com), Joan Gibert Gerez M.D. (firstname.lastname@example.org), Rebeca Cosa Rodríguez M.D. (email@example.com), Mª de los Desamparados Moya Sanz M.D. (firstname.lastname@example.org), Marcos Rodriguez Martín M.D. (email@example.com), Jaime Zorrilla Ortúzar M.D. (firstname.lastname@example.org), José María Pérez-Peña M.D. (email@example.com), Maria Jose Alberola Estellés M.D. (firstname.lastname@example.org), Begoña Ayas Montero Ph.D. (email@example.com), Salome Matoses Jaen M.D. (firstname.lastname@example.org), Sandra Verdeguer Ph.D. (email@example.com), Michiel. Warlé M.D. (Michiel.Warle@radboudumc.nl), David Cuesta Frau Ph.D. (firstname.lastname@example.org.)
O.D.C: Study design, acquisition, analysis and interpretation of data, drafting and revision of paper. B.F.L: Study design, acquisition, analysis and interpretation of data, drafting and revision of paper. G.M: Study design, analysis and interpretation of data, drafting and revision of paper. M.V.M: Study design, acquisition and interpretation of data, and revision of paper. N.G.G: Study design, acquisition and interpretation of data, and revision of paper. D.R.H: Study design, acquisition and interpretation of data, and revision of paper. L.E.O.A: Study design, acquisition and interpretation of data, and revision of paper. M.P.A.N: Study design, interpretation of data, and revision of paper. M.J.S: Analysis and interpretation of data, drafting and revision of paper. C.L.E.O: Study design, analysis and interpretation of data, drafting and revision of paper.
Support was provided solely from institutional and/or departmental sources.
Compliance with Ethical Standards
Oscar Diaz-Cambronero (email@example.com) has received speakers’ fees and honoraria from Merck Sharp & Dohme for lectures (approximately amount: 8.000 euros) and also received a research grant from Merck Sharp & Dohme of 80.000 euros not related to this study. Blas Flor Lorente (firstname.lastname@example.org) has received speakers’ fees and honoraria from Merck Sharp & Dohme for lectures (approximately amount: 3.000 euros). Guido Mazzinari (email@example.com) declares no competing interests. Maria Vila Montañes (firstname.lastname@example.org) declares no competing interests. Nuria Garcia Gregorio (email@example.com) declares no competing interests. Daniel Robles Hernandez (firstname.lastname@example.org) declares no competing interests. Luis Enrique Olmedilla Arnal (email@example.com) declares no competing interests. Maria Pilar Argente Navarro (firstname.lastname@example.org) has received speakers’ fees and honoraria for lectures from Merck Sharp & Dohme (approximately amount: 1.000 euros). Marcus J. Schultz (email@example.com) declares no competing interests. Carlos L. Errando (firstname.lastname@example.org) has received speakers’ fees and honoraria for lectures from Merck Sharp & Dohme. (approximately amount: 1.000 euros).
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