Jake Bumpus, Engineer. NTI
Objective: All laparoscopic surgery that relies on CO2 insufflation gas from a wall source is affected by CO2 gas pressure supplied to the insufflator, as source pressure directly affects the achievable flow rate, and flow rate allows pneumoperitoneum pressure to be maintained during leakages [1]. Increasingly, to support robotically assisted surgeries, healthcare facilities are upgrading their operating rooms to utilize a CO2 central supply, accessible through a port on a wall or surgical boom. While these systems offer logistical advantages, the CO2 pressure must be reduced (commonly 40-70 PSI) [2] relative to directly connecting a compressed CO2 cylinder (>700PSI), which can negatively impact device performance at the point of use. To address this issue, we present an insufflator design which substantially increases the maximum achievable CO2 flow rate at these low source pressures, as compared to three other currently marketed devices.
Description of the Technology: The CO2 flow circuit of the device minimizes restriction points to maximize flow output at a given input pressure. The user interface provides advance notice of any potential low source pressure conditions at startup, so they can be remediated prior to the operation. If CO2 supply is disrupted during the operation, the insufflator provides audiovisual indications and continues to maximize flow, minimizing disruption to the procedure.
Preliminary Results: A measurable disparity between this insufflator design and three other devices on the market was observed. This indicates that the insufflator technology presented here (Insufflator 1) yields a substantial performance improvement over the other three devices, especially in the 40-70PSI pressure ranges typical to central supply systems.
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Conclusions: Based on these results, it is evident that the CO2 inlet pressure significantly and disproportionately affects the maximum achievable insufflation flow rate of each of the four insufflators tested. This disparity could make workable pneumoperitoneum possible for some insufflators, even with low source pressure, which may not be possible with others. Thus, the surgical team must understand whether the insufflator and gas source selected are well-suited to meet the flow requirements of their procedures.
References:
[1] Daskalakis, Markos, Oliver Scheffel, and Rudolf A. Weiner. "High flow insufflation for the maintenance of the pneumoperitoneum during bariatric surgery." Obesity facts 2.Suppl. 1 (2009): 37-40.
[2] International Organization for Standardization. (2016). ISO 7396-1, Third edition; 2016-02-15. Medical gas pipeline systems — Part 1: Pipeline systems for compressed medical gases and vacuum. Retrieved from https://www.iso.org/standard/60061.html
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This abstract was accepted for Poster presentation at the 2020 SAGES Virtual Meeting in the topic. Its program number was: ETP670 and its Abstract ID was: 106139