Comparison of Pneumoperitoneum Stability Between a Valveless Trocar System and Conventional Insufflation: A Prospective Randomized Trial

Bucur, Philip; Hofmann, Martin R.; Menhadji, Ashleigh; Abedi, Garen; Okhunov, Zhamshid; Rinehart, Joseph; Landman, Jaime

doi:10.1016/j.urology.2016.04.022

Cited by 30 publications

(32 citation statements)

References 9 publications

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“…Such insufflators offer stable pneumoperitoneum at low insufflation pressures, and they will be increasingly adopted to minimize leaks and reduce potential operating room staff infections due to aerosolization of virus, particularly in a post COVID-19 era. 3 Bucur et al 4 have compared the performance of the Airseal iFS to a traditional insufflator where they assessed overall degree of pressure variability and time spent within different pressure bands. The present study differs in that it compares accuracy of the insufflators against insufflator setting in dynamic leak conditions where the effects of a variety of induced leaks on performance can be directly appreciated, as opposed to the study by Mowbray et al where the assessment was over the entire duration of each case, 3 which includes many data points where leaks may not have been present.…”

Section: Discussionmentioning

confidence: 99%

Technical Performance of Continuous Pressure Insufflators Versus Traditional Insufflators in the Presence of Leaks During Laparoscopic Surgery

2021

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Background. New insufflators have been developed to manage leaks emanating from the working cavity during laparoscopic surgery. Little data have been published to show the performance of these insufflators. This study evaluates the performance of 2 modern continuous pressure insufflators in various leak conditions. Methods. Performance of a new continuous pressure insufflator, EVA15 (Palliare, Galway, Ireland), was compared with that of a continuous pressure insufflator, Airseal intelligent Flow System (iFS) (CONMED, Utica, NY), and a traditional intermittent pressure insufflator, Endoflator 40 (KARL STORZ, Tuttlingen, Germany). Six different leak scenarios were created in a swine model to create different dynamic leak profiles of between 5 and 15 L/min. Pressure deviation from setting was measured for each insufflator tested. The following were calculated: (a) mean absolute difference of measured insufflation pressure vs. the insufflator pressure setting for the 50 second measurement period (MAD) and (b) standard deviation of the absolute differences (SD). Results. The average mean absolute pressure difference between the EVA15 and Airseal is .27 mmHg. However, the average mean absolute pressure difference between the EVA15 and Endoflator 40 is 2.62 mmHg. Conclusions. Continuous pressure insufflators provide superior pressure delivery performance in leak situations when compared against a traditional intermittent pressure insufflator. No clinically significant performance difference was observed when comparing the EVA15 and Airseal iFS insufflators in the tested leak situations.

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Section: Discussionmentioning

confidence: 99%

Technical Performance of Continuous Pressure Insufflators Versus Traditional Insufflators in the Presence of Leaks During Laparoscopic Surgery

2021

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“…Real-time pressure detection and immediate adjustment with this insufflator system have been shown to maintain a stable pneumoperitoneum even at low pressures [ 28 ]. Bucur et al revealed that the stability preserved with the Airseal® is greater compared to a standard insufflator system [ 29 ]. A visual schematic is displayed in Figure 5 .…”

Section: Reviewmentioning

confidence: 99%

Can We Routinely Employ the Use of Low-Pressure Gynaecological Laparoscopy? A Systematic Review

Hamer¹,

Jones²,

Chan³

et al. 2021

Cureus

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Clinicians have learnt valuable lessons throughout the COV-SARS-2 pandemic, many of which have produced solutions that we aim to continue to implement within the foreseeable future. Optimising patients' surgical pathways to reduce the length of stay and complications is an area of particular importance, both for maximal utilisation of available resources and for reduction of the exposure of inpatient and elective patients to an increased risk of infection within healthcare facilities.The aim of this review was to investigate the possible implications of using low-pressure laparoscopic gynaecological surgery versus standard-or high-pressure pneumoperitoneum surgeries. The primary outcome was postoperative pain, with secondary outcomes including duration of surgery, length of inpatient stay and rate of complications. MEDLINE, Embase and Cochrane CENTRAL were searched from inception to December 2020. We searched for published randomised control trials comparing low-pressure laparoscopic surgery (≤8 mmHg) to at least one additional standardised pneumoperitoneum pressure (≥12 mmHg and/or ≥15 mmHg). A total of 203 studies were reviewed, five of which were included in this analysis. Studies comparing low-pressure laparoscopic surgery against gasless abdominal cavities were excluded.The meta-analysis of the results was pooled and calculated within RevMan 5.0 software (Cochrane, London, England). Studies using a visual analogue scale (1-10) to compare low versus standard pneumoperitoneum pressures did not display a significant diminution of postoperative pain at ≤ 6 or 24 hours: -0.30 [95% CI -0.63, 0.03] and -0.66 [95% CI -1.35, 0.02], respectively. Studies additionally demonstrated worse visualisation of the surgical field within the low-pressure group (risk ratio 10.31; 95% CI, 1.29-82.38 I 2 = 0%). Studies measuring postoperative pain using a numerical rating scale displayed significant pain reduction at all hours measured (p ≤ 0.01). The rate of intraoperative complications was 1% for all groups measured. Cumulative analysis of the duration of surgery did not differ significantly between groups (p = 0.99).The pandemic has revealed new issues that must be addressed by clinicians to promote the safety of patients and the efficiency of inpatient stay. This review has paved the way for new possibilities and innovative approaches to address the issue of optimising patient surgical pathways; however, at present, we cannot give a firm justification for the use of low-pressure gynaecological laparoscopy. Reasons for this include the minimal reduction in pain scores between low, standard and high pneumoperitoneum pressures, leading to a mixture of statistically significant results, as well as a reduction in the visualisation of the surgical field and the small population sizes in the reviewed papers. Additional research is required to further explore the potential clinical benefits of gynaecological laparoscopy to ensure its effective ambulatory use within mainstream surgical operations.

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“…Traditional insufflation (TI) techniques involve the manual adjustment of the pressure of the pneumoperitoneum during the procedure, while smart insufflation (SI) techniques involve the use of low pressure and valve free access 6 . SI techniques are increasingly being utilized as they provide an immediate response time to even small changes in intra-abdominal pressure [6][7][8][9][10][11][12][13][14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

Granular analysis reveals smart insufflation to be operationally more efficient and financially net positive compared to traditional insufflation for laparoscopic surgery

Abbas

Saleh

Hoit

et al. 2023

Preprint

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Introduction: Smart insufflation (SI) techniques relying on valve and membrane-free insufflation are increasing in usage. Although considerable literature exists demonstrating the benefits of SI on procedural ease and patient outcomes, there remains a paucity describing the financial impact of these devices. The purpose of this study was to determine the financial and efficiency impact of these devices on the operating room (OR) and inpatient wards of a hospital. Methods: A discrete event simulation model representing a typical mid-sized North American hospital comparing SI to TI was generated. The National Surgical Quality Improvement (NSQIP) database from 2015 to 2019 was used to populate the model with data supplemented from literature. Outcomes included length of stay (LOS), duration of surgery (DOS), annual procedure volume, profit, return on investment (ROI), and gross profit margin (GPM). Results: The operational parameters demonstrating favorability of SI to TI were DOS and LOS. DOS savings were 10-32 minutes/case while LOS savings were 0-3 days/case. Implementation of an SI led to an increase in annual throughput of 148 cases (12%). LOS decreased by 189 days (19%). This resulted in an increase in net profit of $104,675 per annum. The ROI of SI over TI device was >1000%. Conclusion: Despite the initial financial investment being greater, the implementation of SI offsets these expenses and yields significant financial benefits. Our study demonstrates the financial benefits of SI over TI and illustrates how granular operational and financial analysis of technologies are essential to aid in sound healthcare procurement decision making.

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Comparison of Pneumoperitoneum Stability Between a Valveless Trocar System and Conventional Insufflation: A Prospective Randomized Trial

Cited by 30 publications

References 9 publications

Technical Performance of Continuous Pressure Insufflators Versus Traditional Insufflators in the Presence of Leaks During Laparoscopic Surgery

Technical Performance of Continuous Pressure Insufflators Versus Traditional Insufflators in the Presence of Leaks During Laparoscopic Surgery

Can We Routinely Employ the Use of Low-Pressure Gynaecological Laparoscopy? A Systematic Review

Granular analysis reveals smart insufflation to be operationally more efficient and financially net positive compared to traditional insufflation for laparoscopic surgery

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