Skip to main content

Advertisement

SpringerLink
Log in

Using LAP PROTECTOR™ to prevent subcutaneous emphysema after robotic gastrectomy

  • Research
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

Subcutaneous emphysema (SE), a complication of robotic gastrectomy (RG), occurs when the gas used to establish pneumoperitoneum escapes and enters the soft tissue. SE typically does not result in major clinical problems, but massive SE can have life-threatening consequences. Hence, developing adequate preventive methods against postoperative SE is essential. We aimed to determine whether an existing protective device, the LAP PROTECTOR™ (LP), can be used to reduce the incidence of SE after RG. We analyzed the data of 194 patients who underwent RG at our hospital between August 2016 and December 2022. Since September 2021 (the 102nd patient), we have used the LP (FF0504; Hakko Medical, Hongo, Tokyo, Japan) at the trocar site, as this was expected to reduce the incidence of SE. The primary endpoint of this study was the efficacy of the LP in reducing the incidence of clinically relevant SE (defined as SE extending into the cervical area) a day after RG. Univariate analysis revealed that sex, body mass index (BMI), and LP usage differed significantly between patients with and without postoperative SE. Logistic regression analysis revealed that male sex (odds ratio [OR]: 0.22, 95% confidence interval [CI]: 0.15–0.72, P < 0.001), high BMI (OR: 0.13, 95% CI: 1.23–4.45, P = 0.009), and LP usage (OR: 0.11, 95% CI: 0.04–0.3, P < 0.001) were preventive factors independently associated with a lower incidence of clinically relevant SE. Placing an LP at the trocar site may be a safe and effective method of preventing SE after RG.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

All data used in this study are available in the Supplementary Information file.

References

  1. Ott DE (2014) Subcutaneous emphysema—beyond the pneumoperitoneum. JSLS 18:1–7. https://doi.org/10.4293/108680813X13693422520882

    Article  PubMed  PubMed Central  Google Scholar 

  2. Shah SB, Dubey M, Meghana D (2020) An algorithm for management of intraoperative subcutaneous emphysema during robotic surgery. Saudi J Anaesth 14:269–270. https://doi.org/10.4103/sja.SJA_711_19

    Article  PubMed  PubMed Central  Google Scholar 

  3. Tan PL, Lee TL, Tweed WA (1992) Carbon dioxide absorption and gas exchange during pelvic laparoscopy. Can J Anaesth 39:677–681. https://doi.org/10.1007/BF03008229

    Article  CAS  PubMed  Google Scholar 

  4. Lehmann LJ, Lewis MC, Goldman H, Marshall JR (1995) Cardiopulmonary complications during laparoscopy: two case reports. South Med J 88:1072–1075. https://doi.org/10.1097/00007611-199510000-00015

    Article  CAS  PubMed  Google Scholar 

  5. Celik H, Cremins A, Jones KA, Harmanli O (2013) Massive subcutaneous emphysema in robotic sacrocolpopexy. JSLS 17:245–248. https://doi.org/10.4293/108680813X13654754535151

    Article  PubMed  PubMed Central  Google Scholar 

  6. Capone J, De Ranieri A, Knezevic NN, Lukić IK, Candido K, Gluncic V (2019) Massive upper body and cervicofacial subcutaneous emphysema following robotic myomectomy. Case Rep Anesthesiol 2019:5861705. https://doi.org/10.1155/2019/5861705

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dumont SW, Farag A (2008) Life threatening subcutaneous emphysema. Anaesthesia 63:212–213. https://doi.org/10.4103/0019-5049.179469

    Article  CAS  PubMed  Google Scholar 

  8. Murdock CM, Wolff AJ, Van Geem T (2000) Risk factors for hypercarbia, subcutaneous emphysema, pneumothorax, and pneumomediastinum during laparoscopy. Obstet Gynecol 95:704–709. https://doi.org/10.1016/s0029-7844(00)00781-x

    Article  CAS  PubMed  Google Scholar 

  9. Saggar VR, Singhal A, Singh K, Sharma B, Sarangi R (2008) Factors influencing development of subcutaneous carbon dioxide emphysema in laparoscopic totally extraperitoneal inguinal hernia repair. J Laparoendosc Adv Surg Tech A 18:213–216. https://doi.org/10.1089/lap.2007.0089

    Article  PubMed  Google Scholar 

  10. Japanese Gastric Cancer Association (2021) Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 24:1–21. https://doi.org/10.1007/s10120-020-01042-y

    Article  Google Scholar 

  11. Uyama I, Kanaya S, Ishida Y, Inaba K, Suda K, Satoh S (2012) Novel integrated robotic approach for suprapancreatic D2 nodal dissection for treating gastric cancer: technique and initial experience. World J Surg 36:331–337. https://doi.org/10.1007/s00268-011-1352-8

    Article  PubMed  Google Scholar 

  12. Suda K, Nakauchi M, Inaba K, Ishida Y, Uyama I (2016) Robotic surgery for upper gastrointestinal cancer: current status and future perspectives. Dig Endosc 28:701–713. https://doi.org/10.1111/den.12697

    Article  PubMed  Google Scholar 

  13. McAllister JD, D’Altorio RA, Snyder A (1991) CT findings after uncomplicated percutaneous laparoscopic cholecystectomy. J Comput Assist Tomogr 15:770–772. https://doi.org/10.1097/00004728-199109000-00008

    Article  CAS  PubMed  Google Scholar 

  14. Kukuruza K, Aboeed A (2022) Subcutaneous emphysema. StatPearls Publishing LLC, St. Petersburg, FL StatPearls

    Google Scholar 

  15. Fukui S, Kagebayashi Y, Iemura Y, Matsumura Y (2022) Severe subcutaneous emphysema caused by small injury to the abdominal wall during robot-assisted laparoscopic radical prostatectomy. Urol Case Rep 40:101904. https://doi.org/10.1016/j.eucr.2021.101904

    Article  PubMed  Google Scholar 

  16. Worrell JB, Cleary DT (2002) Massive subcutaneous emphysema and hypercarbia: complications of carbon dioxide absorption during extraperitoneal and intraperitoneal laparoscopic surgery—case studies. AANA J 70:456–461

    PubMed  Google Scholar 

  17. Luketina R, Luketina TLH, Antoniou SA, Köhler G, Könneker S, Manzenreiter L, Wundsam H, Koch OO, Knauer M, Emmanuel K (2021) Prospective randomized controlled trial on comparison of standard CO(2) pressure pneumoperitoneum insufflator versus AirSeal®. Surg Endosc 35:3670–3678. https://doi.org/10.1007/s00464-020-07846-4

    Article  PubMed  Google Scholar 

  18. Razdan S, Ucpinar B, Okhawere KE, Badani KK (2023) The role of AirSeal in robotic urologic surgery: a systematic review. J Laparoendosc Adv Surg Tech A 33:21–31. https://doi.org/10.1089/lap.2022.0153

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Editage for English language editing.

Funding

This research received no specific grant from any funding agency.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kuratsukihigashi, 2 Chome-1, Kanazawa, Ishikawa, 920-8530, Japan

    Kengo Hayashi, Yusuke Sakimura, Takahisa Yamaguchi, Yoshinao Obatake, Shiro Terai, Hirotaka Kitamura, Shinichi Kadoya & Hiroyuki Bando

  2. Department of Gastrointestinal Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa, 920-8641, Japan

    Noriyuki Inaki

Authors
  1. Kengo Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Noriyuki Inaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yusuke Sakimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takahisa Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshinao Obatake
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shiro Terai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hirotaka Kitamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shinichi Kadoya
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroyuki Bando
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by KH. The first draft of the manuscript was written by KH, and all authors read and approved the final manuscript.

Corresponding author

Correspondence to Kengo Hayashi.

Ethics declarations

Conflict of interest

Drs Kengo Hayashi, Noriyuki Inaki, Yusuke Sakimura, Takahisa Yamaguchi, Yoshinao Obatake, Shiro Terai, Hirotaka Kitamura, Shinichi Kadoya, and Hiroyuki Bando have no conflicts of interest to disclose.

Ethical approval

This study was performed in accordance with the principles of the World Medical Association’s Declaration of Helsinki (ethical principles for medical research involving human subjects). This study was approved by the ethics committee of Ishikawa Prefectural Central Hospital (approval no. 2077).

Consent to participate

Each patient enrolled in this study provided written informed consent for the surgery and for the use of clinical data in research.

Consent to publish

The authors affirm that human research participants provided informed consent for publication of the images in Fig. 2.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hayashi, K., Inaki, N., Sakimura, Y. et al. Using LAP PROTECTOR™ to prevent subcutaneous emphysema after robotic gastrectomy. J Robotic Surg 17, 2297–2303 (2023). https://doi.org/10.1007/s11701-023-01651-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-023-01651-6

Keywords

Search

Navigation