On-demand endoscopic CO2 insufflation with feedback pressure regulation during natural orifice transluminal endoscopic surgery (NOTES) peritoneoscopy induces minimal hemodynamic and respiratory changes

Background Endoscopic insufflation has been associated with marked increase in intra-abdominal pressure (IAP) and hemodynamic and respiratory changes during transgastric surgery. Objective To investigate the hemodynamic and respiratory effects during intraperitoneal cavity exploration through 3 diff...

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Published in:Gastrointestinal endoscopy 2012-08, Vol.76 (2), p.388-395
Main Authors: Navarro-Ripoll, Ricard, MD, Martínez-Pallí, Graciela, MD, PhD, Guarner-Argente, Carlos, MD, Córdova, Henry, MD, Martínez-Zamora, Maria Angels, MD, PhD, Comas, Jaume, MD, Rodríguez de Miguel, Cristina, Beltrán, Mireia, Rodríguez-D'Jesús, Antonio, MD, Hernández-Cera, Clara, MD, Llach, Josep, MD, PhD, Balust, Jaume, MD, Fernández-Esparrach, Glòria, MD, PhD
Format: Article
Language:English
Subjects:
Animals
Biological and medical sciences
Blood Gas Analysis
Carbon Dioxide - administration & dosage
Carbon Dioxide - blood
Female
Gastroenterology and Hepatology
Gastroenterology. Liver. Pancreas. Abdomen
Hemodynamics
Insufflation - adverse effects
Insufflation - methods
Laparoscopy - methods
Medical sciences
Natural Orifice Endoscopic Surgery - methods
Outcome Assessment (Health Care)
Oxygen - blood
Peritoneal Cavity - surgery
Pressure
Prospective Studies
Pulmonary Gas Exchange
Random Allocation
Swine
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Summary:Background Endoscopic insufflation has been associated with marked increase in intra-abdominal pressure (IAP) and hemodynamic and respiratory changes during transgastric surgery. Objective To investigate the hemodynamic and respiratory effects during intraperitoneal cavity exploration through 3 different natural orifice transluminal endoscopic surgery (NOTES) access locations compared with laparoscopy. Design and Setting Survival experiments using 40 female pigs randomized to transgastric, transcolonic, transvaginal, and laparoscopic peritoneoscopy. Interventions On-demand endoscopic insufflation of CO2 with feedback pressure regulation was used in NOTES with a maximum pressure of 14 mm Hg. In the laparoscopy group, the IAP was maintained at 14 mm Hg. NOTES procedures were performed by an endoscopist (with the assistance of a gynecologist in the transvaginal group and a second endoscopist in the transgastric and transrectal groups) and laparoscopy by 2 surgeons. Main Outcome Measurements Invasive hemodynamic and respiratory data. Blood samples were drawn for gas analyses. Results All experiments except one in the transrectal group were completed. The IAP was significantly lower in all NOTES groups compared with the laparoscopy group. A significant increase in mean systemic arterial blood pressure was observed in the laparoscopy group at 15 and 30 minutes of intraperitoneal cavity exploration, but it remained unchanged during all NOTES procedures. An increase in airway pressures was observed at 15 and 30 minutes of peritoneoscopy in the animals undergoing laparoscopy, whereas those parameters remained unchanged in the NOTES groups. The laparoscopy group showed a significant impairment in pulmonary gas exchange (decrease in Pa o2 , increase in Paco2 , and decrease in arterial pH) after 30 minutes of peritoneoscopy, whereas only a slight increase in Pa co2 was observed in the transrectal and transvaginal groups. Limitations Healthy animal model. Conclusion On-demand endoscopic insufflation of CO2 with feedback pressure regulation can minimize the risk of hemodynamic and respiratory compromise caused by acute changes in IAP.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2011.10.015