A Prospective, Randomized, Clinical Trial on the Effects of a Valveless Trocar on Respiratory Mechanics During Robotic Radical Cystectomy: A Pilot Study

Covotta, Marco; Claroni, Claudia; Torregiani, Giulia; Naccarato, Alessia; Tribuzi, Susanna; Zinilli, Antonio; Forastiere, Ester

doi:10.1213/ane.0000000000002027

Cited by 26 publications

(25 citation statements)

References 29 publications

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“…On the other hand, it is unclear how the AirSeal ® played a role in the positive responses because we did not compare the data from a conventional insufflation system. However, two studies [ 2 , 21 ] demonstrated that CO 2 elimination was significantly reduced with the AirSeal ® versus conventional insufflation system. CO 2 elimination rates are reportedly directly related to CO 2 absorption rates when the patient remains metabolically constant [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of AirSeal® insufflation system on respiratory and circulatory dynamics during laparoscopic abdominal surgery

et al. 2022

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The effect of the AirSeal ® insufflation system on hemodynamic parameters, especially end-tidal carbon dioxide (EtCO 2 ), during laparoscopic abdominal surgery remains unclear. This retrospective single-center study included 333 consecutive patients who underwent laparoscopic hepatectomy ( n = 43), gastrectomy ( n = 69), colectomy ( n = 137), or proctectomy ( n = 84) using the AirSeal ® . Patient demographics and intraoperative hemodynamic parameters, such as EtCO 2 , peripheral capillary oxygen saturation (SpO 2 ), and arterial systolic blood pressure (ABP), were collected and analyzed. EtCO 2 was evaluated during the entire operative period (whole period) as well as the pneumoperitoneum period until specimen removal (pneumoperitoneum period). We defined “positive respiratory and circulatory responses” (positive responses) as a decrease in EtCO 2 ≥ 3 mmHg in addition to decreases in SpO 2 ≥ 3% and ABP ≥ 10 mmHg simultaneously, which suggest possible carbon dioxide (CO 2 ) embolism. The median EtCO 2 values of hepatectomy, gastrectomy, colectomy, and proctectomy in the whole period/pneumoperitoneum period were 37.3/37.4, 37.1/37.3, 37.4/37.9, and 38.2/38.4 mmHg, respectively. The EtCO 2 of proctectomy was significantly higher than that of gastrectomy during the whole and pneumoperitoneum periods ( P < 0.05). In contrast, the EtCO 2 of hepatectomy was comparable to that of the other three surgeries in the whole and pneumoperitoneum periods. Meanwhile, nine (2.7%; eight hepatectomies and one proctectomy) patients showed positive responses, and one who underwent a partial hepatectomy developed a clinically manifested CO 2 embolism. Positive responses occurred during venous exposure or bleeding in all nine cases. Although the EtCO 2 of hepatectomy was comparable to that of the other surgeries using the AirSeal ® , laparoscopic hepatectomy showed a tendency of CO 2 embolism. Thus, a secure and careful surgical approach is mandatory for laparoscopic hepatectomy using the AirSeal ® insufflation system.

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Section: Discussionmentioning

confidence: 99%

Impact of AirSeal® insufflation system on respiratory and circulatory dynamics during laparoscopic abdominal surgery

et al. 2022

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“…Minute ventilation has to be increased by up to 15% to match the respiratory demand generated by increased CO 2 resorption in pneumoperitoneum [25]. The use of a valve-less trocar by the surgeons has been shown to improve respiratory mechanics in robot-assisted radical cystectomy and could help to ease ventilatory demands if prolonged pneumoperitoneum is required [26]. If ventilatory adjustment is not possible, the surgeons should be asked to reduce IAP or stop the CO 2 flow for a few minutes.…”

Section: Co 2 Resorptionmentioning

confidence: 99%

Do Small Incisions Need Only Minimal Anesthesia?—Anesthetic Management in Laparoscopic and Robotic Surgery

Hottenrott

Schlesinger

Helmer

et al. 2020

JCM

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Laparoscopic techniques have established themselves as a major part of modern surgery. Their implementation in every surgical discipline has played a vital part in the reduction of perioperative morbidity and mortality. Precise robotic surgery, as an evolution of this, is shaping the present and future operating theatre that an anesthetist is facing. While incisions get smaller and the impact on the organism seems to dwindle, challenges for anesthetists do not lessen and could even become more demanding than in open procedures. This review focuses on the pathophysiological effects of contemporary laparoscopic and robotic procedures and summarizes anesthetic challenges and strategies for perioperative management.

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“…Furthermore, CO2 use is demonstrated to be significantly decreased using such a system, resulting in a potential reduction in CO2-related complications; this is of particular benefit for patients with impaired cardiopulmonary function [ 11 ]. In randomized experiments in urology, the system improved visualization and reduced cardiopulmonary damage compared to standard insufflation [ 12 , 13 , 14 ]. The AirSeal platform has been evaluated in general gynecologic surgery, mainly in cases of benign disease [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Low-Pressure Laparoscopy Using the AirSeal System versus Standard Insufflation in Early-Stage Endometrial Cancer: A Multicenter, Retrospective Study (ARIEL Study)

et al. 2022

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The aim of our study was to evaluate the benefits of a low-pressure insufflation system (AirSeal) vs. a standard insufflation system in terms of anesthesiologists’ parameters and postoperative pain in patients undergoing laparoscopic surgery for early-stage endometrial cancer. This retrospective study involved five tertiary centers and included 152 patients with apparent early-stage disease who underwent laparoscopic surgical staging with either the low-pressure AirSeal system (8–10 mmHg, n = 84) or standard laparoscopic insufflation (10–12 mmHg, n = 68). All the intraoperative anesthesia variables evaluated (systolic blood pressure, end-tidal CO2, peak airway pressure) were significantly lower in the AirSeal group. We recorded a statistically significant difference between the two groups in the median NRS scores for global pain recorded at 4, 8, and 24 h, and for overall shoulder pain after surgery. Significantly more women in the AirSeal group were also discharged on day one compared to the standard group. All such results were confirmed when analyzing the subgroup of women with a BMI >30 kg/m2. In conclusion, according to our preliminary study, low-pressure laparoscopy represents a valid alternative to standard laparoscopy and could facilitate the development of outpatient surgery.

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A Prospective, Randomized, Clinical Trial on the Effects of a Valveless Trocar on Respiratory Mechanics During Robotic Radical Cystectomy: A Pilot Study

Abstract: During RARC, use of a VT was associated with a significantly lower Pplat and improvement in other respiratory parameters.

Cited by 26 publications

References 29 publications

Impact of AirSeal® insufflation system on respiratory and circulatory dynamics during laparoscopic abdominal surgery

Impact of AirSeal® insufflation system on respiratory and circulatory dynamics during laparoscopic abdominal surgery

Do Small Incisions Need Only Minimal Anesthesia?—Anesthetic Management in Laparoscopic and Robotic Surgery

Low-Pressure Laparoscopy Using the AirSeal System versus Standard Insufflation in Early-Stage Endometrial Cancer: A Multicenter, Retrospective Study (ARIEL Study)

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