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

Abstract

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.

Escape of surgical smoke particles, comparing conventional and valveless trocar systems

“…During this study, the total volume displacement was 30 mL at a simulated respiratory frequency of 15 breaths per minute. The diaphragm distortion in the model was similar to the pressure pattern described by Perretta et al [ 7 ]. The actual displacements used for the study are added as Supplementary file 1.…”

“…However, some controversy exists on the use of valveless trocar systems. Previous studies have shown that their use can lead to the entrainment of air [ 6 , 7 ] which might affect peritoneal pressure, humidity, carbon dioxide concentration, and temperature [ 8 ].…”