Optimizing working space in laparoscopy: CT measurement of the influence of small body size in a porcine model

Abstract Introduction In our continuing research into the determinants of laparoscopic working space, the influence of small body size was investigated. Methods In eight 6-kg pigs, the effects of intraabdominal CO2 pneumoperitoneum pressure (IAP), prestretching of the abdominal wall, and neuromuscul...

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Bibliographic Details
Published in:Journal of pediatric surgery 2015-03, Vol.50 (3), p.465-471
Main Authors: Vlot, John, Staals, Lonneke M.E, Wijnen, René M.H, Stolker, Robert Jan, Bax, Klaas(N) M.A
Format: Article
Language:English
Subjects:
Abdomen
Abdominal Wall
Animal model
Animals
Body Size
Carbon Dioxide - administration & dosage
Female
Humans
Insufflation - methods
Laparoscopy
Laparoscopy - methods
Models, Animal
Neuromuscular blockade
Pediatrics
Pressure
Prestretching
Surgery
Sus scrofa
Swine
Tomography, X-Ray Computed
Working space
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Summary:Abstract Introduction In our continuing research into the determinants of laparoscopic working space, the influence of small body size was investigated. Methods In eight 6-kg pigs, the effects of intraabdominal CO2 pneumoperitoneum pressure (IAP), prestretching of the abdominal wall, and neuromuscular blockade (NMB) on laparoscopic working space volume and distances were studied. Computed tomography was used to measure working space during two stepwise abdominal insufflation-runs up to an IAP of 15 mm Hg. Results were compared with data from earlier experiments in 20-kg pigs. Results Cardiorespiratory parameters were stable up to an IAP of 8–10 mm Hg. In 6-kg pigs working-space dimensions were five times smaller than in 20-kg pigs. Working-space volume, anteroposterior (AP) diameter and symphysis-diaphragm distance increased linearly up to an IAP of 8 mm Hg. Above 8 mm Hg, compliance decreased. Eighty percent of the total volume (618 ml) and of AP diameter (3 cm) at 15 mm Hg had been achieved at an IAP of 10 mm Hg. Prestretching by a first insufflation resulted in a statistically significant increase in working space volume and in AP diameter during the second insufflation. This effect was significantly larger than in 20-kg pigs. Neuromuscular blockade did not have a significant effect on working-space. Conclusions Working space in growing individuals is very limited. Eighty percent of the working space created by an IAP of 15 mm Hg was already achieved at 10 mm Hg, while cardiorespiratory side effects at an IAP of 8–10 mm Hg seem acceptable. Prestretching of the abdominal wall significantly increased working space, even more so than in 20-kg pigs. As in 20-kg pigs, NMB had no significant effect on laparoscopic working space. Prestretching of the abdominal wall is a promising cheap, safe and easy strategy to increase laparoscopic working space, lessening the need for prolonged high-pressure pneumoperitoneum.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2014.05.037