A multifaceted individualized pneumoperitoneum strategy for laparoscopic colorectal surgery: a multicenter observational feasibility study

Fecha de publicación: 01/01/2019

Autores de IIS La Fe

• 

  Óscar Díaz Cambronero

  Autor

• María Vila Montañés

  Autor

• Nuria García Gregorio

  Autor

• María Pilar Argente Navarro

  Autor

• Salvador Pous Serrano

  Autor

• 

  Matteo Frasson

  Autor

• Álvaro García-Granero García-Fuster

  Autor

• Eduardo García-Granero Ximénez

  Autor

• Ana Isabel Marqués Marí

  Autor

Participantes ajenos a IIS La Fe

• Lorente, BF
• Mazzinari, G
• Hernandez, DR
• Arnal, LEO
• Schultz, MJ
• Errando, CL
• Ballester, C
• Santacruz, CC
• Guillen, LS
• Rodrigo, DC
• Gerez, JG
• Rodriguez, RC
• Sanz, MDM
• Martin, MR
• Ortuzar, JZ
• Perez-Pena, JM
• Estelles, MJA
• Montero, BA
• Jaen, SM
• Verdeguer, S
• Warle, M
• Frau, DC
• IPPColLapSe Study Grp

Grupos

• Cirugía digestiva y Cuidados perioperatorios

  

  Leader

  Matteo Frasson

• Medicina Perioperatoria, Anestesiología y Reanimación

  

  Leader

  Óscar Díaz Cambronero

Abstract

BackgroundWhile 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.MethodsMulticenter 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.ResultsNinety-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, 8mmHg. In 17 patients, IAP was raised up to 12mmHg. The relationship between IAP and driving pressure was almost linear. The mean estimated intra-abdominal CO2 volume at which surgery was performed was 3.2L.ConclusionA 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).

Keywords

• Laparoscopy; Colorectal surgery; Neuromuscular blockade