Rashid Kikhia, MD1, Kristie Price1, Vamsi Alli, MD2, Aurora Pryor, MD1, Gerald Gracia1, Jerry Rubano, MD1, Jessica Schnur1, Dana Telem, MD3. 1Stony Brook Medicine, 2Penn State, 3University of Michigan
Background: Pneumoperitoneum produces significant hemodynamic and cardiopulmonary changes. At present abdominal insufflation to 15mmHg is standard during laparoscopy; however, even at that accepted pressure studies demonstrate increased mean end tidal CO2 (etCO2) and airway pressures. Thus, operating at reduced pressure may confer physiologic benefits. We aimed to assess the safety and efficacy of operating at a lower intra-abdominal pressure as well as the potential value of an insufflation management system versus conventional C02 insufflation to maintain these pressures.
Methods: Between January 2016 and August 2016, a continuous quality improvement project prospectively collected data on 51 patients who underwent laparoscopic cholecystectomy at 10mmHg. Cholecystectomy was performed either with a conventional C02 insufflator (CI) or an insufflation management system (IMS). Bivariate statistical analysis was used to compare preoperative, intraoperative and postoperative data with p-values <0.05 considered significant.
Results: Of the 51 patients, 25 underwent cholecystectomy with IMS and 26 CI. No significant difference in preoperative demographics, acuity of operation, body mass index or laboratory values were demonstrated. Mean intraoperative pressure was 10.6±1.6 mmHg for IMS versus 11.1±1.8 mmHg for CI (p=NS). Insufflation pressure was increased in 32% of IMS vs. 44% of CI patients (p=NS). No significant difference in etC02 (35.2 vs. 35.2), mean airway pressure (10.1 vs. 9.6), intraoperative complications (4% vs. 1%) or operative time (50 vs. 42 minutes) was demonstrated between IMS and CI, respectively. Postoperatively, PACU total morphine equivalents given was significantly decreased in IMS as compared to the CI group (21.8 vs. 41.4, p=0.04) as was length of stay based on incision start time (19.6 vs. 30 hours, p=0.03). No difference in PACU VAS pain scores was demonstrated. No differences in pain or complications were demonstrated at 30-days.
Conclusions: Operating at lower intra-abdominal pressures is safe, feasible and may be associated with a more favorable ventilatory profile as compared to averages cited in the literature. While not significant, a trend in maintenance and stability of lower pressure was demonstrated with utilization of IMS. Despite similar VAS scores, PACU length of stay and morphine requirements were significantly reduced in IMS patients. This finding suggests a recovery benefit to patients who underwent surgery with IMS; however, more studies are needed to corroborate this finding.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80062
Program Number: P113
Presentation Session: Poster (Non CME)
Presentation Type: Poster