Impact of valve-less vs. standard insufflation on pneumoperitoneum volume, inflammation, and peritoneal physiology in a laparoscopic sigmoid resection experimental model - CNRS - Centre national de la recherche scientifique Accéder directement au contenu
Article Dans Une Revue Surgical Endoscopy Année : 2018

Impact of valve-less vs. standard insufflation on pneumoperitoneum volume, inflammation, and peritoneal physiology in a laparoscopic sigmoid resection experimental model

Andras Legner
  • Fonction : Auteur
Seong-Ho Kong
  • Fonction : Auteur
Yu-Yin Liu
  • Fonction : Auteur
Luigi Schiraldi
  • Fonction : Auteur
Francesco Marchegiani
  • Fonction : Auteur
Anne-Laure Charles
  • Fonction : Auteur
Bernard Dallemagne
  • Fonction : Auteur
Jacques Marescaux
  • Fonction : Auteur

Résumé

Standard insufflators compensate for intra-abdominal pressure variations with pressure spikes. Our aim was to evaluate the impact of a stable, low-pressure pneumoperitoneum induced by a valve-less insufflator, on working space, hemodynamics, inflammation, and peritoneal physiology, in a model of laparoscopic sigmoid resection. Twelve pigs (47 +/- 3.3 kg) were equipped for invasive hemodynamic monitoring and randomly assigned to Standard (n = 6) vs. valve-less (n = 6) insufflation. Animals were positioned in a 30A degrees Trendelenburg on a CT scan bed. A low-pressure pneumoperitoneum (8 mmHg) was started and duration was set for 180 min. Abdominal CT scans were performed, under neuromuscular blockade, before, immediately after, and 1 and 3 h after insufflation. Pneumoperitoneum volumes were calculated on 3D reconstructed CT scans. After creation of a mesenteric window, capillary blood was obtained by puncturing the sigmoid serosa and local lactatemia (mmol/L) was measured using a handheld analyzer. Surgical resection was performed according to the level of lactates, in order to standardize bowel stump perfusion. IL-1 and IL-6 (ng/mL) were measured repeatedly. The peritoneum was sampled close to the surgical site and distantly for the oxygraphic assessment of mitochondrial respiration. A pathologist applied a semi-quantitative score to evaluate the anastomosis. Mean arterial pressure, pulse, body temperature, oximetry, systemic lactatemia, and local lactates were similar. IL-6 was lower in the valve-less group, reaching a statistically significant difference after 3 h of insufflation (64.85 +/- 32.5 vs. 133.95 +/- 59.73; p = 0.038) and 48 h (77.53 +/- 68.4 vs. 190.74 +/- 140.79; p = 0.029). Peritoneal mitochondrial respiration was significantly increased after the survival period, with no difference among the groups. The anastomoses in the valve-less group demonstrated a lower acute (p = 0.04) inflammatory infiltration. The mean anterior posterior thickness was slightly, yet significantly higher in the valve-less group, on all post-insufflation CT scans. Valve-less insufflation achieved a slightly higher working space and a lower systemic and localized inflammatory response in this experimental setting.
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Dates et versions

hal-03935573 , version 1 (11-01-2023)

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Citer

Michele Diana, Eric Noll, Andras Legner, Seong-Ho Kong, Yu-Yin Liu, et al.. Impact of valve-less vs. standard insufflation on pneumoperitoneum volume, inflammation, and peritoneal physiology in a laparoscopic sigmoid resection experimental model. Surgical Endoscopy, 2018, 32 (7), pp.3215-3224. ⟨10.1007/s00464-018-6039-x⟩. ⟨hal-03935573⟩
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