Portal de Periódicos da CAPES

A multifaceted individualized pneumoperitoneum strategy for laparoscopic colorectal surgery: a multicenter observational feasibility study

2018; Springer Science+Business Media; Volume: 33; Issue: 1 Linguagem: Inglês

10.1007/s00464-018-6305-y

1866-6817

Óscar Díaz‐Cambronero, Blas Flor‐Lorente, Guido Mazzinari, Maria Vila Montañes, Nuria García Gregorio, Daniel Robles, L. E. Olmedilla Arnal, María Pilar Navarro, Marcus J. Schultz, C.L. Errando, Salvador Pous, Cristina Ballester, Matteo Frasson, Álvaro García‐Granero, Carlos Cerdán Santacruz, Eduardo García‐Granero, Luis Sánchez‐Guillén, Anabel Marqués Marí, David Casado Rodrigo, J. Gibert Gerez, Rebeca Cosa Rodríguez, Ma de los Desamparados Moya Sanz, M. Rodríguez Martín, Jaime Zorrilla, Jose María Pérez-Peña, María José Alberola Estellés, Begoña Ayas Montero, Salomé Matoses Jaén, S. Verdeguer, Michiel C. Warlé, David Cuesta–Frau,

Hemodynamic Monitoring and Therapy

While guidelines for laparoscopic abdominal surgery advise using the lowest possible intra-abdominal pressure, commonly a standard pressure is used. We evaluated the feasibility of a predefined multifaceted individualized pneumoperitoneum strategy aiming at the lowest possible intra-abdominal pressure during laparoscopic colorectal surgery. Multicenter prospective study in patients scheduled for laparoscopic colorectal surgery. The strategy consisted of ventilation with low tidal volume, a modified lithotomy position, deep neuromuscular blockade, pre-stretching of the abdominal wall, and individualized intra-abdominal pressure titration; the effect was blindly evaluated by the surgeon. The primary endpoint was the proportion of surgical procedures completed at each individualized intra-abdominal pressure level. Secondary endpoints were the respiratory system driving pressure, and the estimated volume of insufflated CO2 gas needed to perform the surgical procedure. Ninety-two patients were enrolled in the study. Fourteen cases were converted to open surgery for reasons not related to the strategy. The intervention was feasible in all patients and well-accepted by all surgeons. In 61 out of 78 patients (78%), surgery was performed and completed at the lowest possible IAP, 8 mmHg. In 17 patients, IAP was raised up to 12 mmHg. The relationship between IAP and driving pressure was almost linear. The mean estimated intra-abdominal CO2 volume at which surgery was performed was 3.2 L. A multifaceted individualized pneumoperitoneum strategy during laparoscopic colorectal surgery was feasible and resulted in an adequate working space in most patients at lower intra-abdominal pressure and lower respiratory driving pressure. ClinicalTrials.gov (Trial Identifier: NCT03000465).