Ciara R Huntington, MD1, Bradley Lopes, BS2, Kerstin Hazelbaker2, Clifford B LeMaster, PhD2, Thomas R Huntington, MD3. 1Carolinas Medical Center, 2Boise State University, 3St. Luke’s Regional Medical Center
BACKGROUND/OBJECTIVE: Valveless laparoscopic insufflator systems are marketed for ability to prevent loss of abdominal collapse and desufflation during laparoscopy. However, community surgeons raised concern for possible entrainment of room air, including oxygen (02), with these systems. This study seeks to quantify O2 and non-medical air entrainment by a laparoscopic valveless cannula system to understand the risk of intraoperative air embolism. A community-university collaborative was created to design a model and test this hypothesis.
METHODS: An artificial abdomen was developed and calibrated to equivalent compliance and intraoperative volume of an average adult abdomen. It was connected to a flow meter, oxygen concentration sensor, and commercially available laparoscopic valveless cannula system. Intraabdominal concentration of oxygen was measured at 0-65 liters per minute (L/min) of insufflated carbon dioxide (CO2) leak, as would occur by laparoscopic suctioning, For reference, one model of laparoscopic suction devices created a 42L gas leak per min. At the test facility, room air measured to be 19.4% O2. Microsoft Excel 2016 (Redmond, WA) was utilized for descriptive statistics and data collection.
RESULTS: At 0 L/min CO2 leak, there was minimal (0.4%) oxygen detected intraabdominally. However, when CO2 leak occurred, as would occur during suction or instrument exchange, increasing amounts of 02 was detected intraabdominally: 1.73% average measured 02 concentration at 5L/min CO2 leak, 1.62% at 10L/min CO2 leak, 1.78% at 15L/min CO2 leak, 5.59% at 25L/min CO2 leak, 7.89% at 35L/min CO2 leak, 8.6% at 45L/min CO2 leak, 10.25% at 55L/min CO2 leak, and 9.99% at 65L/min CO2 leak. The rapid introduction of O2 and room air was confirmed by comparing the measured, delivered CO2 volume per minute from the insufflator to the total CO2 leakage rate—this deficit corroborated the introduction of non-medical room air into the abdomen.
CONCLUSION: Valveless laparoscopic insufflator systems have potential to entrain room air into the abdomen during standard intraoperative use. This represents a significant safety hazard with potential for gas embolism with non-absorbable oxygen and nitrogen.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88332
Program Number: P479
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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