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Published on: March 24, 2023
A novel lifting system for minimally accessed surgery: a prospective comparison between "Laparo-V" gasless and CO2
Jeng-Kai Jiang1, Wei-Shone Chen, Shyh-Jen Wang
1Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China. jkjiang@vghtpe.gov.tw
Purpose:
Carbon dioxide (CO(2)) pneumoperitoneum can lead to cardiopulmonary loading and complications. By comparing with conventional CO(2) pneumoperitoneum approach, we introduce a novel Laparo-V lifting system for gasless laparoscopic colorectal surgery.
Methods:
In a prospective study, patients with colonic lesions underwent either Laparo-V gasless (n = 20) or conventional CO(2) pneumoperitoneum (n = 19) laparoscopic colectomy. Twenty patients who underwent open surgery were enrolled as control. Intra-operative monitoring includes blood pressures, heart rate, O(2) saturation, and end-tidal CO(2) (ET-CO(2)). Serum level of interleukin 6 (IL-6), C-reactive protein (CRP), cortisol, and lymphocyte subpopulations (CD4/CD8) were measured repeatedly. Postoperative recovery was indicated by return of bowel function and postoperative hospital stay.
Results:
Patient characteristics were not different between the three groups. There were three conversions in each laparoscopy group, making conversion rates 15% and 15.7% for Laparo-V and CO(2) pneumoperitoneum groups, respectively. Vital signs remained stable in Laparo-V and open surgery groups; while, elevated ET-CO(2) and heart rate were noted in CO(2) pneumoperitoneum group. Both laparoscopy groups had a significant faster recovery and shorter hospital stay than the open surgery group. Postoperative elevation of IL-6, CRP, and cortisol level was observed in all the three groups, of note, the change was most significant in the open surgery group.
Conclusions:
Laparo-V gasless laparoscopic approach is feasible in various colorectal procedures. It carries advantages comparable with those of CO(2) pneumoperitoneum; while, the intra-operative hemodynamic was more stable. Therefore, laparoscopic approach using the Laparo-V system could be beneficial to patients with high cardiopulmonary risk and represents an alternative for minimally invasive surgery.
