Hai Hu, MD, Kai Zhang, Gang Zhao. East Hospital Affiliated with Tongji University
Aims: Traditional laparoendoscopic surgery introduces risks for CO2 pneumoperitoneum-associated complications, and existing gasless laparoendoscopic surgeries have are associated with low visibility of the operative field. To overcome the disadvantages of the current lifting gasless laparoendoscopic operation platforms, we developed an inflatable device for gasless laparoscopic operative field formation (LOFF) that can be internally installed and applied in clinical practice.
Patients and methods: we initially designed six types of operation platforms for gasless laparoendoscopic single-site surgery (GLESS). Subsequently, these platforms were screened in animal experiments. Ultimately, a triangular prismatic LOFF device was selected and applied successfully to GLESS cholecystectomy of five pigs. Using such an animal model, three surgical approaches (LOFF-assisted laparoendoscopic single-site (LOFF-LESS), LESS surgery, and traditional lifting (GLESS)) were compared to evaluate their advantages and disadvantages. Sixty clinical patients were selected and randomly divided into two groups to receive either LOFF-LESS or LESS surgery. A number of parameters including operating time, amount of intraoperative blood loss, postoperative complications, postoperative wound pain and shoulder-back pain, cosmetic satisfaction of surgical incisions, and long-term surgical complications were recorded.
Results: After the LOFF device was placed inside the abdominal cavity for 4 h, the surrounding small intestine, stomach, liver, and omenta did not show damage significantly different from that which occurred under the regular pneumoperitoneum situation. Of the five LOFF-aided LESS operations in five pigs, all of five operations were completed smoothly. The comparison of LOFF-LESS, LESS, and GLESS surgeries in animal experiments demonstrated that LOFF-LESS and LESS surgeries did not result in any differences in the time required for operative field formation or in the operating time for gallbladder removal. Under the same gasless conditions, the LOFF-LESS approach resulted in a superior exposure of Calot's triangle compared to the GLESS approach, thus avoiding the latter method’s shortcoming of poor visibility in the operative field. The comparison using two groups of patients receiving either LOFF-LESS or LESS surgery indicated that the two surgical approaches did not exhibit significant differences. However, LOFF-LESS surgery led to a significantly decreased incidence of postoperative shoulder-back pain compared with LESS. Blood gas analysis before and after surgery showed that LOFF-LESS surgery resulted in higher PO2 and lower PCO2, and significantly reduced the disturbance of CO2 pneumoperitoneum on the cardiopulmonary functions of patients.
Conclusions: The LOFF device provides a type of operation platform that can be internally installed and inflated for GLESS operation. The clinical results verified that LOFF-assisted LESS surgery is safe, effective, and feasible. In addition to the advantages of less pain, faster recovery, and extremely high cosmetic satisfaction after surgery, the LOFF-LESS approach can reduce the incidence of pneumoperitoneum-related complications. We believe that with further improvement, the LOFF platform can eventually overcome the current bottleneck in the application of gasless laparoendoscopic surgery, thus promoting its development and broadening its application scope.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 90943
Program Number: ET003
Presentation Session: Emerging Technology Session (Non CME)
Presentation Type: Podium