• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Optimizing Working-space in Laparoscopy: the Effect of Pre-stretching of the Abdominal Wall in a Porcine Model

John Vlot, MD, Rene Wijnen, Prof, Robert Jan Stolker, Prof, Klaas Bax, Prof

Erasmus MC Sophia, Depts. of Pediatric Surgery and Anesthesiology

Introduction
Adequate working space is a prerequisite for safe and efficient minimal access surgery (MAS). In a research line with a porcine model investigating the effect of various interventions aimed at increasing working space we noticed a positive effect of brief abdominal insufflation (pre-stretching) up to a (relatively) high intra-abdominal pressure (IAP).

Methods and procedures
Twenty female 20kg pigs were studied. Eight animals received mechanical bowel preparation (MBP) in the context of other investigations. Anesthesia was strictly protocolized with volume-controlled ventilation and continuous monitoring of cardiorespiratory parameters. No neuromuscular blocking agents were used. An electronic CO2 insufflator was attached to an abdominal trocar. End-expiratory CT-scans were made at stepwise increased IAPs of 0, 5, 10 and 15mm Hg. At each pressure level a 5 minutes stabilization period was taken into account before CT scanning. After desufflation of the abdomen, the abdomen was insufflated again up to an IAP of 5mm Hg and scans were repeated. Intra-abdominal CO2 volume for all pressure-levels was calculated from reconstructed CT-images. Data were analyzed using SPSS version 20 and volumes were compared using a paired-samples T-test.

Results
One animal died unexpectedly during instrumentation before the start of the actual experiment. Data from three other animals were incomplete, leaving 16 animals for analysis. An increase in the CO2 pneumoperitoneum volume at repeat insufflation up to an IAP of 5mm Hg was seen in all but one animal. The mean volume at an IAP of 5mm Hg increased by pre-stretching from 1507ml to 1821ml, a 21% increase (SD 209ml). This increase was highly significant (p<0.01). There was no difference between MBP and no MBP animals

Conclusion
A 21% increase in the CO2 pneumoperitoneum volume at an IAP of 5mm Hg was found after short pre-stretching of the abdominal wall up to an IAP of 15mm Hg. The practice of short pre-stretching offers an opportunity for increasing working space in MAS without the disadvantages of long lasting high IAP. Further experiments are needed to examine the sustainability of this effect.


Session: Poster Presentation

Program Number: P018

168

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons