The physiopathologic consequences of pneumoperitoneum are well known. In the attempt to minimize CO2 peritonel uptake and the related physiological consequences, a new generation of insufflation systems and trocars are in development. This experimental animal study aims to assess the applicability and safety of a new insufflation and trocar system for laparoscopic surgery: the AirSeal TM (Surgiquest, Orange CT USA).
Materials and methods:
Twelve mini-pigs were randomized to laparoscopic cholecystectomy using the the Thermoflator® (Karl Storz, Tuttlingen Germany) or the AirSeal TM system. The AirSeal TM system is supplied with a re-circulation and filtration pump designed to maintain pneumoperitoneum while minimizing CO2 consumption. All the procedures were performed by a single surgical and anaesthetic team. Intraoperative monitoring measured at baseline, before insufflation, and every 5 min thereafter included: body core temperature, ECG, systemic arterial blood pressures, SpO2, peak and mean airway pressures, total amount of CO2 insufflated, and E TCO2. At baseline and at the end of the procedure blood gases, IL6 and lactic acid level were also evaluated. The feasibility was measured by operative time (min), intraoperative complications and surgeon’s satisfaction (bad, fair, good or excellent).
Both groups had similar operative time and surgeon’s satisfaction. No intraoperative complications occurred. No significant difference was noted for blood pressures, airway pressures and compliance, arterial oxygenation, pH, lactic acid and IL6 level across the 2 groups The monitoring of E TCO2 excluded gas embolism in both groups and showed a trend towards higher expired CO2 in the control group.
In this preliminary series, the AirSealTM system was equivalent to the standard Thermoflator® and well accepted by the surgeons. The minor CO2 consumption and consequent less important increase in E TCO2 observed with the AirSeal system, are important findings. Whether this corresponds to a different pattern of peritoneal CO2 absorbtion, needs to be further explored in a dedicated randomized controlled trial.
Program Number: P079