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A novel lifting system for minimally accessed surgery: a prospective comparison between “Laparo-V” gasless and CO2 pneumoperitoneum laparoscopic colorectal surgery

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Carbon dioxide (CO2) pneumoperitoneum can lead to cardiopulmonary loading and complications. By comparing with conventional CO2 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 CO2 pneumoperitoneum (n = 19) laparoscopic colectomy. Twenty patients who underwent open surgery were enrolled as control. Intra-operative monitoring includes blood pressures, heart rate, O2 saturation, and end-tidal CO2 (ET-CO2). 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 CO2 pneumoperitoneum groups, respectively. Vital signs remained stable in Laparo-V and open surgery groups; while, elevated ET-CO2 and heart rate were noted in CO2 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 CO2 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.

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References

  1. Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial.[see comment]. Lancet 363(9416):1187–1192

    Article  PubMed  Google Scholar 

  2. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial.[see comment]. Lancet 359:2224–2229

    Article  PubMed  Google Scholar 

  3. Curet MJ, Putrakul K, Pitcher DE, Josloff RK, Zucker KA (2000) Laparoscopically assisted colon resection for colon carcinoma: perioperative results and long-term outcome. Surg Endosc 14:1062–1066

    Article  CAS  PubMed  Google Scholar 

  4. Clinical Outcomes of Surgical Therapy Study G (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  5. Ogihara Y, Isshiki A, Kindscher JD, Goto H (1999) Abdominal wall lift versus carbon dioxide insufflation for laparoscopic resection of ovarian tumors. J Clin Anesth 11:406–412

    Article  CAS  PubMed  Google Scholar 

  6. Woolley DS, Puglisi RN, Bilgrami S, Quinn JV, Slotman GJ (1995) Comparison of the hemodynamic effects of gasless abdominal distention and CO2 pneumoperitoneum during incremental positive end-expiratory pressure. J Surg Res 58:75–80

    Article  CAS  PubMed  Google Scholar 

  7. Horvath KD, Whelan RL, Lier B, Viscomi S, Barry L, Buck K, Bessler M (1998) The effects of elevated intraabdominal pressure, hypercarbia, and positioning on the hemodynamic responses to laparoscopic colectomy in pigs.[see comment]. Surg Endosc 12:107–114

    Article  CAS  PubMed  Google Scholar 

  8. Takagi S (1998) Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy. Surg Endosc 12:427–431

    Article  CAS  PubMed  Google Scholar 

  9. Gutt CN, Kim ZG, Hollander D, Bruttel T, Lorenz M (2001) CO2 environment influences the growth of cultured human cancer cells dependent on insufflation pressure. Surg Endosc 15:314–318

    Article  CAS  PubMed  Google Scholar 

  10. Wittich P, Steyerberg EW, Simons SH, Marquet RL, Bonjer HJ (2000) Intraperitoneal tumor growth is influenced by pressure of carbon dioxide pneumoperitoneum. Surg Endosc 14:817–819

    Article  CAS  PubMed  Google Scholar 

  11. Ridgway PF, Smith A, Ziprin P, Jones TL, Paraskeva PA, Peck DH, Darzi AW (2002) Pneumoperitoneum augmented tumor invasiveness is abolished by matrix metalloproteinase blockade. Surg Endosc 16:533–536

    Article  CAS  PubMed  Google Scholar 

  12. Hewett PJ, Texler ML, Anderson D, King G, Chatterton BE (1999) In vivo real-time analysis of intraperitoneal radiolabeled tumor cell movement during laparoscopy. Dis Colon Rectum 42:868–875, discussion 875–866

    Article  CAS  PubMed  Google Scholar 

  13. Bossotti M, Bona A, Borroni R, Mattio R, Coda A, Ferri F, Martino F, Dellepiane M (2001) Gasless laparoscopic-assisted ileostomy or colostomy closure using an abdominal wall-lifting device. Surg Endosc 15:597–599

    Article  CAS  PubMed  Google Scholar 

  14. Akira S, Abe T, Igarashi K, Nishi Y, Kurose K, Watanabe M, Takeshita T (2005) Gasless laparoscopic surgery using a new intra-abdominal fan retractor system: an experience of 500 cases. J Nippon Med Sch 72:213–216

    Article  PubMed  Google Scholar 

  15. Ishida H, Hashimoto D, Inokuma S, Nakada H, Ohsawa T, Hoshino T (2003) Gasless laparoscopic surgery for ulcerative colitis and familial adenomatous polyposis: initial experience of 7 cases. Surg Endosc 17:899–902

    Article  CAS  PubMed  Google Scholar 

  16. Critchley LA, Critchley JA, Gin T (1993) Haemodynamic changes in patients undergoing laparoscopic cholecystectomy: measurement by transthoracic electrical bioimpedance. Br J Anaesth 70:681–683

    Article  CAS  PubMed  Google Scholar 

  17. Holzman M, Sharp K, Richards W (1992) Hypercarbia during carbon dioxide gas insufflation for therapeutic laparoscopy: a note of caution. Surg Laparosc Endosc 2:11–14

    CAS  PubMed  Google Scholar 

  18. Westerband A, Van De Water J, Amzallag M, Lebowitz PW, Nwasokwa ON, Chardavoyne R, Abou-Taleb A, Wang X, Wise L (1992) Cardiovascular changes during laparoscopic cholecystectomy. Surg Gynecol Obstet 175:535–538

    CAS  PubMed  Google Scholar 

  19. Lacy AM, Delgado S, Garcia-Valdecasas JC, Castells A, Pique JM, Grande L, Fuster J, Targarona EM, Pera M, Visa J (1998) Port site metastases and recurrence after laparoscopic colectomy. A randomized trial. Surg Endosc 12:1039–1042

    Article  CAS  PubMed  Google Scholar 

  20. Schaeff B, Paolucci V, Thomopoulos J (1998) Port site recurrences after laparoscopic surgery. A review. Dig Surg 15:124–134

    Article  CAS  PubMed  Google Scholar 

  21. Z’Graggen K, Birrer S, Maurer CA, Wehrli H, Klaiber C, Baer HU (1998) Incidence of port site recurrence after laparoscopic cholecystectomy for preoperatively unsuspected gallbladder carcinoma. Surgery 124:831–838

    Article  PubMed  Google Scholar 

  22. Mutter D, Hajri A, Tassetti V, Solis-Caxaj C, Aprahamian M, Marescaux J (1999) Increased tumor growth and spread after laparoscopy vs laparotomy: influence of tumor manipulation in a rat model. Surg Endosc 13:365–370

    Article  CAS  PubMed  Google Scholar 

  23. Watson DI, Mathew G, Ellis T, Baigrie CF, Rofe AM, Jamieson GG (1997) Gasless laparoscopy may reduce the risk of port-site metastases following laparascopic tumor surgery. Arch Surg 132:166–168, discussion 169

    CAS  PubMed  Google Scholar 

  24. Jacobi CA, Sabat R, Bohm B, Zieren HU, Volk HD, Muller JM (1997) Pneumoperitoneum with carbon dioxide stimulates growth of malignant colonic cells. Surgery 121:72–78

    Article  CAS  PubMed  Google Scholar 

  25. Kitano S, Tomikawa M, Iso Y, Iwata S, Gondo K, Moriyama M, Sugimachi K (1992) A safe and simple method to maintain a clear field of vision during laparoscopic cholecystectomy. Surg Endosc 6:197–198

    Article  CAS  PubMed  Google Scholar 

  26. Horvath KD, Whelan RL, Lier B, Viscomi S, Barry L, Bessler M, Buck KA, Treat MR (1997) A prospective comparison of laparoscopic exposure techniques for rectal mobilization and sigmoid resection. J Am Coll Surg 184:506–512

    CAS  PubMed  Google Scholar 

  27. Smith RS, Fry WR, Tsoi EK, Henderson VJ, Hirvela ER, Koehler RH, Brams DM, Morabito DJ, Peskin GW (1993) Gasless laparoscopy and conventional instruments. The next phase of minimally invasive surgery. Arch Surg 128:1102–1107

    CAS  PubMed  Google Scholar 

  28. Johnson PL, Sibert KS (1997) Laparoscopy. Gasless vs. CO2 pneumoperitoneum. J Reprod Med 42:255–259

    CAS  PubMed  Google Scholar 

  29. Jiang JK, Chen WS, Yang SH, Lin TC, Lin JK (2001) Gasless laparoscopy-assisted colorectal surgery. Surg Endosc 15:1093–1097

    Article  CAS  PubMed  Google Scholar 

  30. Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 93:921–928

    Article  CAS  PubMed  Google Scholar 

  31. Hewett PJ, Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Rieger NA, Smith JS, Solomon MJ, Stephens JH, Stevenson AR (2008) Short-term outcomes of the Australasian randomized clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: the ALCCaS trial. Ann Surg 248:728–738

    Article  PubMed  Google Scholar 

  32. Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328

    Article  PubMed  Google Scholar 

  33. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  34. Galizia G, Prizio G, Lieto E, Castellano P, Pelosio L, Imperatore V, Ferrara A, Pignatelli C (2001) Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum and abdominal wall-lifting cholecystectomy. A prospective, randomized study. Surg Endosc 15:477–483

    Article  CAS  PubMed  Google Scholar 

  35. Gupta A, Watson DI (2001) Effect of laparoscopy on immune function. Br J Surg 88:1296–1306

    Article  CAS  PubMed  Google Scholar 

  36. Buunen M, Gholghesaei M, Veldkamp R, Meijer DW, Bonjer HJ, Bouvy ND (2004) Stress response to laparoscopic surgery: a review. Surg Endosc 18:1022–1028

    Article  CAS  PubMed  Google Scholar 

  37. Grande M, Tucci GF, Adorisio O, Barini A, Rulli F, Neri A, Franchi F, Farinon AM (2002) Systemic acute-phase response after laparoscopic and open cholecystectomy. Surg Endosc 16:313–316

    Article  CAS  PubMed  Google Scholar 

  38. Solomon MJ, Young CJ, Eyers AA, Roberts RA (2002) Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg 89:35–39

    Article  CAS  PubMed  Google Scholar 

  39. Uzunkoy A, Coskun A, Akinci OF, Kocyigit A (2000) Systemic stress responses after laparoscopic or open hernia repair. Eur J Surg 166:467–471

    Article  CAS  PubMed  Google Scholar 

  40. Ordemann J, Jacobi CA, Schwenk W, Stosslein R, Muller JM (2001) Cellular and humoral inflammatory response after laparoscopic and conventional colorectal resections. Surg Endosc 15:600–608

    Article  CAS  PubMed  Google Scholar 

  41. Wu FP, Sietses C, von Blomberg BM, van Leeuwen PA, Meijer S, Cuesta MA (2003) Systemic and peritoneal inflammatory response after laparoscopic or conventional colon resection in cancer patients: a prospective, randomized trial. Dis Colon Rectum 46:147–155

    Article  CAS  PubMed  Google Scholar 

  42. Hewitt PM, Ip SM, Kwok SP, Somers SS, Li K, Leung KL, Lau WY, Li AK (1998) Laparoscopic-assisted vs. open surgery for colorectal cancer: comparative study of immune effects. Dis Colon Rectum 41:901–909

    Article  CAS  PubMed  Google Scholar 

  43. Liang JT, Shieh MJ, Chen CN, Cheng YM, Chang KJ, Wang SM (2002) Prospective evaluation of laparoscopy-assisted colectomy versus laparotomy with resection for management of complex polyps of the sigmoid colon. World J Surg 26:377–383

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China

    Jeng-Kai Jiang, Wei-Shone Chen & Jen-Kou Lin

  2. School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China

    Jeng-Kai Jiang, Wei-Shone Chen & Jen-Kou Lin

  3. Division of Experimental Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China

    Wei-Shone Chen & Shyh-Jen Wang

  4. Division of Colorectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan, 11217, China

    Jeng-Kai Jiang

Authors
  1. Jeng-Kai Jiang
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  2. Wei-Shone Chen
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  4. Jen-Kou Lin
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Corresponding author

Correspondence to Jeng-Kai Jiang.

Additional information

Authors’ contributions

Jeng-Kai Jiang is first and corresponding author. He contributed to the conceptual design of the Laparo-V system and performed gasless laparoscopy surgery. He also performed the majority of data acquisition and all data analysis, and writing of the manuscript.

Wei-Shone Chen is the second author. He was helping in the recruitment of the patients and performed all the CO2 pneumoperitoneal laparoscopy surgery. He also took part in data acquisition and analysis.

Shyh-Jen Wang is the third author. He contributed to the design and manufacturing of the Laparo-V system.

Jen-Kou Lin assisted with patient recruitment and clinical data acquisition.

Supported by Taipei Veterans General Hospital Research Fund (VGH93-069)

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Jiang, JK., Chen, WS., Wang, SJ. et al. A novel lifting system for minimally accessed surgery: a prospective comparison between “Laparo-V” gasless and CO2 pneumoperitoneum laparoscopic colorectal surgery. Int J Colorectal Dis 25, 997–1004 (2010). https://doi.org/10.1007/s00384-010-0942-5

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