Underneath Images and Robots, Looking Deeper into the Pneumoperitoneum: A Narrative Review.

Fecha de publicación: 14/02/2024 Fecha Ahead of Print: 14/02/2024

Autores de IIS La Fe

• Guido Mazzinari

  Autor

• Blas Flor Lorente

  Autor

• 

  Óscar Díaz Cambronero

  Autor

Participantes ajenos a IIS La Fe

• Rovira, Lucas
• Albers-Warle, Kim I.
• Warle, Michiel C.
• Argente-Navarro, Pilar

Grupos

• Cirugía digestiva y Cuidados perioperatorios

  

  Leader

  Matteo Frasson

• Medicina Perioperatoria, Anestesiología y Reanimación

  

  Leader

  Óscar Díaz Cambronero

Abstract

Laparoscopy offers numerous advantages over open procedures, minimizing trauma, reducing pain, accelerating recovery, and shortening hospital stays. Despite other technical advancements, pneumoperitoneum insufflation has received little attention, barely evolving since its inception. We explore the impact of pneumoperitoneum on patient outcomes and advocate for a minimally invasive approach that prioritizes peritoneal homeostasis. The nonlinear relationship between intra-abdominal pressure (IAP) and intra-abdominal volume (IAV) is discussed, emphasizing IAP titration to balance physiological effects and surgical workspace. Maintaining IAP below 10 mmHg is generally recommended, but factors such as patient positioning and surgical complexity must be considered. The depth of neuromuscular blockade (NMB) is explored as another variable affecting laparoscopic conditions. While deep NMB appears favorable for surgical stillness, achieving a balance between IAP and NMB depth is crucial. Temperature and humidity management during pneumoperitoneum are crucial for patient safety and optical field quality. Despite the debate over the significance of temperature drop, humidification and the warming of insufflated gas offer benefits in peritoneal homeostasis and visual clarity. In conclusion, there is potential for a paradigm shift in pneumoperitoneum management, with dynamic IAP adjustments and careful control of insufflated gas temperature and humidity to preserve peritoneal homeostasis and improve patient outcomes in minimally invasive surgery.

Keywords

• pneumoperitoneum; laparoscopic surgery; minimally invasive surgery; intra-abdominal pressure (IAP); peritoneal homeostasis; abdominal compliance; neuromuscular blockade (NMB); perioperative temperature control