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Comparing Conventional and Valveless Trocar Insufflation During Laparoscopic Renal Surgery

Abstract

ABSTRACT OF THE THESIS

Comparing Conventional and Valveless Trocar Insufflation During Laparoscopic Renal Surgery

By

Philip Bucur

Master of Science – Biomedical and Translational Science

University of California, Irvine, 2015

Professor Jaime Landman, Chair

We compared the variation in pneumoperitoneum, physiologic effects, and postoperative outcomes of patients undergoing laparoscopic renal surgery using a conventional insufflation system (CI) versus the valveless trocar insufflation (VI) system.

This is a prospective, randomized comparative study with fifty-six patients undergoing laparoscopic renal surgery with valveless trocar insufflation or conventional insufflation. Patients in the valveless insufflation arm (n=28) underwent surgery using the AirSeal valveless trocar insufflation system whereas patients in the conventional treatment arm (n=28) underwent surgery using standard laparoscopic trocars connected to a Storz insufflator with the insufflation pressure set to 15 mm Hg. We compared the groups with respect to stability of pneumoperitoneum, intraoperative and postoperative outcomes, and physiologic parameters.

The coefficient of variation in pressures was significantly lower in the valveless trocar group compared to the conventional treatment group (7.9% vs. 15.6%, p<0.001) with significantly less time spent above insufflation pressures of 20 mm Hg. Estimated blood loss was significantly higher in the valveless trocar group than conventional group (155 vs. 75 cc, p=0.03). End-tidal CO2 (ET CO2) was significantly lower at 10 minutes (34.3 vs. 36.6 mmHg, p=0.029) and 25 minutes (35.8 vs. 37.6 mmHg, p=0.047) in the valveless trocar group compared to the conventional treatment group. There were no other significant differences across physiologic parameters or outcomes.

In conclusion, compared with a conventional insufflation system, the valveless trocar insufflation system provides a significantly more stable pneumoperitoneum during laparoscopic renal surgery and lower end-tidal CO2 at 10 minutes, but with an increased risk of blood loss.

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