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Preperitoneal insufflation pressure of the abdominal wall in a porcine model

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Abstract

Background

Most complications and adverse events during laparoscopic surgery occur during initial entry into the peritoneal cavity. Among them, preperitoneal insufflation occurs when the insufflation needle is incorrectly placed, and the abdominal wall is insufflated. The objective of this study was to find a range for static pressure which is low enough to allow placement of a Veress needle into the peritoneal space without causing preperitoneal insufflation, yet high enough to separate abdominal viscera from the parietal peritoneum.

Methods

A pressure test was performed on twelve fresh porcine carcasses to determine the minimum preperitoneal insufflation pressure and the minimum initial peritoneal cavity insufflation pressure. Each porcine model had five needle placement categories. One category tested the initial peritoneal cavity insufflation pressure beneath the umbilicus. The four remaining categories tested the preperitoneal insufflation pressure at four different anatomical locations on the abdomen that can be used for initial entry. The minimum initial insufflation pressures from each carcass were then compared to the preperitoneal insufflation pressures to obtain an optimal range for initial insufflation.

Results

Increasing the insufflation pressure increased the probability of preperitoneal insufflation. Also, there was a statistically significant difference (p < 0.05) between the initial peritoneal cavity insufflation pressures (8.83 ± 4.19 mmHg) and the lowest preperitoneal pressures (32.54 ± 7.84 mmHg) (mean ± SD).

Conclusion

Pressures greater than 10 mmHg resulted in initial cavity insufflation and pressures greater than 20 mmHg resulted in preperitoneal insufflation in porcine models. By knowing the minimum pressure required to separate the layers of the abdominal wall, the risk of preperitoneal insufflation can be mitigated while obtaining safe and efficient entry into the peritoneal cavity. The findings in this research are not a guideline for trocar or Veress needle placement, but instead reveal preliminary data which may lead to more studies, technology, etc.

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Acknowledgements

The project was funded by the Department of Defense—Offutt Air Force Base -STRATCOM award number FA460018D9001;FU911. The animal handling and surgical work were supported by the Institutional Animal Care staff, veterinarians, and technicians from the University of Nebraska—Lincoln.

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Author notes

  1. Riley E. Reynolds and Benjamin P. Wankum have contributed equally as primary authors.

Authors and Affiliations

  1. Department of Mechanical Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA

    Riley E. Reynolds, Benjamin P. Wankum, Sean J. Crimmins & Benjamin S. Terry

  2. Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA

    Mark A. Carlson

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  1. Riley E. Reynolds
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Correspondence to Benjamin P. Wankum.

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Riley Reynolds, Benjamin Wankum, Sean Crimmins, Mark Carlson, and Benjamin Terry have no conflicts of interest or financial ties to disclose. The views expressed are solely those of the authors and do not reflect the official policy or position of the US Army, US Navy, US Air Force, the Department of Defense, or the US Government.

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Reynolds, R.E., Wankum, B.P., Crimmins, S.J. et al. Preperitoneal insufflation pressure of the abdominal wall in a porcine model. Surg Endosc 36, 300–306 (2022). https://doi.org/10.1007/s00464-020-08275-z

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