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Urology. 2016 Aug;94:274-80. doi: 10.1016/j.urology.2016.04.022. Epub 2016 Apr 27.

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

Author information

1
Department of Urology, University of California, Irvine, Irvine, CA.
2
Department of Anesthesiology & Perioperative Care, University of California, Irvine, Irvine, CA.
3
Department of Urology, University of California, Irvine, Irvine, CA. Electronic address: landmanj@uci.edu.

Abstract

OBJECTIVE:

To compare the variation in pneumoperitoneum and physiologic effects of patients undergoing laparoscopic renal surgery using the valveless trocar insufflation system (VI) vs a conventional insufflation system (CI).

METHODS AND MATERIALS:

We conducted a single-center, randomized controlled trial in patients undergoing renal surgery at 15 mm Hg insufflation using a VI system vs a CI system. The primary outcome measured was variation in insufflation pressure, and end-tidal CO2 at 10 and 25 minutes.

RESULTS:

Fifty-six patients (VI n = 28 or CI n = 28) met inclusion criteria and were randomized. There was significantly less variability in pressure readings, as measured by coefficient of variation, during VI compared to CI (7.8% vs 15.6%, P < .001). There was significantly less time spent within the range with pressure readings ≥18 mm Hg (median 0.2% vs 16.5%, P < .001) and ≤12 mm Hg (median 1.7% vs 5.6%, P = .011) during VI compared to CI. Additionally, there was significantly less time spent with pressure readings in the "unacceptable" range of ≥20 mm Hg (median 0% vs 0.08%, P < .001) and ≤10 mm Hg (median 0.09% vs 2.6%, P < .001) during the cases with VI compared to CI. End-tidal CO2 was significantly lower at 10 minutes (P = .036) after insufflation in the valveless trocar group compared to the conventional treatment group. There were no other significant differences in physiologic metrics.

CONCLUSION:

Compared with a CI, the VI provides a significantly more stable pneumoperitoneum during laparoscopic renal surgery and lower end-tidal CO2 at 10 minutes.

PMID:
27130263
DOI:
10.1016/j.urology.2016.04.022
[Indexed for MEDLINE]

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