A multifaceted individualized pneumoperitoneum strategy for laparoscopic colorectal surgery: a multicenter...

Area of Science:

• Minimally Invasive Surgery
• Surgical Physiology
• Anesthesiology

Background:

• Laparoscopic abdominal surgery guidelines recommend the lowest possible intra-abdominal pressure (IAP).
• Standard IAP is commonly used, deviating from guidelines.
• This study evaluates a novel strategy for individualized IAP in laparoscopic colorectal surgery.

Purpose of the Study:

• To assess the feasibility of a multifaceted, individualized pneumoperitoneum strategy.
• To achieve the lowest possible intra-abdominal pressure during laparoscopic colorectal surgery.
• To evaluate the impact on respiratory system driving pressure and CO2 volume.

Main Methods:

• Multicenter prospective study involving patients undergoing laparoscopic colorectal surgery.
• Strategy included low tidal volume ventilation, modified lithotomy position, deep neuromuscular blockade, abdominal wall pre-stretching, and individualized IAP titration.
• Surgeon's evaluation of the surgical space was blinded; primary endpoint was procedure completion at individualized IAP.

Main Results:

• The strategy was feasible in all 92 enrolled patients and well-accepted by surgeons.
• Surgery was completed at the lowest possible IAP (8 mmHg) in 78% of patients (61/78).
• In 17 patients, IAP was raised to 12 mmHg; a near-linear relationship was observed between IAP and driving pressure. Mean CO2 volume was 3.2 L.

Conclusions:

• A multifaceted individualized pneumoperitoneum strategy is feasible for laparoscopic colorectal surgery.
• This approach provides an adequate surgical working space at lower IAP and reduced respiratory driving pressure.
• The strategy offers a potentially safer alternative to standard IAP in laparoscopic colorectal procedures.