High-pressure laparoscopic entry does not adversely affect cardiopulmonary function in healthy women

Abu-Rafea, Basim; Vilos, George A.; Vilos, Angelos G.; Ahmad, Riad; Hollett-Caines, Jackie; Al-Omran, M.

doi:10.1016/j.jmig.2005.07.393

Cited by 38 publications

(25 citation statements)

References 19 publications

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“…The HR changes observed in the present study when intraperitoneal pressure returned to 12 mmHg in group P20 (TP3) were not reported by Abu-Rafea et al [30], probably because they did not measure patient HR when intraperitoneal pressure returned to 12 mmHg. Those authors did not establish parameters to evaluate possible changes in respiratory function and gas exchange.…”

Section: Discussioncontrasting

confidence: 87%

“…The literature lacks studies investigating this issue. The only study we found did not establish parameters to evaluate changes in respiratory function and gas exchange [30]. In addition, the effect of each preset pressure level (10,15,20,25, and 30 mmHg) was evaluated at the exact moment it was reached, without taking into consideration the cumulative effect of duration of pneumoperitoneum at the different pressure levels to which the patients were submitted.…”

mentioning

confidence: 99%

“…In addition, the effect of each preset pressure level (10,15,20,25, and 30 mmHg) was evaluated at the exact moment it was reached, without taking into consideration the cumulative effect of duration of pneumoperitoneum at the different pressure levels to which the patients were submitted. This hindered the assessment of the effects that might have resulted from the duration of pneumoperitoneum at one specific level rather than from the level of intraperitoneal pressure reached [30].…”

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confidence: 99%

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Creation of pneumoperitoneum: noninvasive monitoring of clinical effects of elevated intraperitoneal pressure for the insertion of the first trocar

et al. 2009

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Transitory, high intraperitoneal pressure (20 mmHg for 5 min) for insertion of the first trocar resulted in changes in HR, MAP, ETCO(2), and ITP that were within the normal range, and no adverse clinical effects were observed. Therefore, the use of transitory, high intraperitoneal pressure is recommended to prevent iatrogenic injury during blind insertion of the first trocar. Nevertheless, it is not clear that this method would be safe in patients with moderate to severe chronic obstructive pulmonary disease.

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Section: Discussioncontrasting

confidence: 87%

mentioning

confidence: 99%

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confidence: 99%

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Creation of pneumoperitoneum: noninvasive monitoring of clinical effects of elevated intraperitoneal pressure for the insertion of the first trocar

et al. 2009

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“…Only four bowel injuries (0.04%) and one major vessel injury (0.01%) were reported. Although the method leads to a significant decline in pulmonary compliance of about 20%, the maximum respiratory effects at 25 to 30 mmHg did not differ from the effect of the Trendelenburg position with intra-abdominal pressures of 15 mmHg [2,44,47,48].…”

Section: The Optical Veress Needlementioning

confidence: 74%

Entry techniques in gynecologic laparoscopy—a review

et al. 2011

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Laparoscopy is one of the most common surgical procedures in gynecologic medicine. Major complications associated with gynecologic laparoscopy are relatively rare, with up to 50% related to laparoscopic entry. Several entry techniques have been developed, all of which aim to provide a safe and easy entry to the abdominal cavity. In this article, we aim to review the available evidence on laparoscopic entry techniques in gynecologic surgery. We found no evidence that the Hasson (open) technique is superior to the Veress needle entry, the preferred method of most gynecologists all over the world. When entering the abdomen using the Veress needle, an intraperitoneal pressure <10 mmHg is a reliable predictor of correct intraperitoneal placement. Entry at Palmer's point (left upper quadrant laparoscopy) is recommended for patients with suspected or known periumbilical adhesions, or a history or presence of umbilical hernia, or after three failed insufflation attempts at the umbilicus. Recently published trials suggest that direct trocar entry, especially when using optical trocar systems, might be superior to both the Hasson open technique and the Veress needle entry to avoid extraperitoneal insufflation and failed entry. Moreover, blood loss can be reduced and the mean entry time shortened. Laparoscopic entry techniques are still a controversial topic in gynecologic surgery. Many studies are underpowered in order to assess the risk for rare but lifethreatening complications. In conclusion, there is no solid evidence proving the superiority of any method of laparoscopic entry.

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“…Prospective observational studies have shown that higher intraabdominal CO 2 insufflated pressures achieve greater anterior abdominal wall splinting and intraabdominal CO 2 gas bubble space [108,[153][154][155]. An IAP of 25 mmHg has been shown to achieve a maximum safe distance between the anterior abdominal wall and underlying abdominal contents without compromising cardiorespiratory function [156,157]. A two-handed, screwing manner-controlled vertical (90°) entry of only the primary trocar tip uses the safe CO 2 bubble depth afforded through an IAP of 25 mmHg and is highly unlikely to injure underlying vessels according to actual laparoscopy [113,146,147] and abdominal vasculature CT mapping studies [111,112,145].…”

Section: Controlled Vertical (90°) Veress Needle Entry (Steps 4 and 5)mentioning

confidence: 99%

Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications

Varma

Gupta

2008

Surg Endosc

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Background This study aimed to establish criteria for safe laparoscopic entry through a systematic literature search and evidence-based medicine appraisal, to determine surgeon preferences for laparoscopic entry in the United Kingdom, and to appraise the medicolegal ramifications of complications arising from laparoscopic entry. Methods A systematic literature search of MEDLINE and EMBASE (1996-2007) was performed as well as a national surgeon survey by questionnaire (May-December 2006). Results Laparoscopic entry criteria involving 10 steps were established based on the systematic literature search and evidence-based critical appraisal. The national survey had 226 respondents, with the majority aware of the Middlesbrough consensus or Royal College of Obstetricians and Gynaecologists [RCOG]-sourced guidance. There was considerable variation in preferred laparoscopic entry techniques. Currently, there is clear judicial guidance on the medicolegal stance toward laparoscopic entry-related complications. Conclusions Despite widespread awareness of laparoscopic entry guidelines, there remains considerable variation in the techniques adopted in clinical practice. Unless practice concurs with recommended guidance, women undergoing laparoscopy will be exposed to increased unnecessary operative risk. Laparoscopic entry-related injury in an uncomplicated woman is considered negligent practice according to UK legal case law.

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High-pressure laparoscopic entry does not adversely affect cardiopulmonary function in healthy women

Cited by 38 publications

References 19 publications

Creation of pneumoperitoneum: noninvasive monitoring of clinical effects of elevated intraperitoneal pressure for the insertion of the first trocar

Creation of pneumoperitoneum: noninvasive monitoring of clinical effects of elevated intraperitoneal pressure for the insertion of the first trocar

Entry techniques in gynecologic laparoscopy—a review

Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications

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