A novel lifting system for minimally accessed surgery: a prospective comparison between "Laparo-V" gasless and CO2 pneumoperitoneum laparoscopic colorectal surgery.
OBJECTIVE
Carbon dioxide (CO(2)) pneumoperitoneum can lead to cardiopulmonary loading and complications. By comparing with conventional CO(2) pneumoperitoneum approach, we introduce a novel Laparo-V lifting system for gasless laparoscopic colorectal surgery.


METHODS
In a prospective study, patients with colonic lesions underwent either Laparo-V gasless (n = 20) or conventional CO(2) pneumoperitoneum (n = 19) laparoscopic colectomy. Twenty patients who underwent open surgery were enrolled as control. Intra-operative monitoring includes blood pressures, heart rate, O(2) saturation, and end-tidal CO(2) (ET-CO(2)). Serum level of interleukin 6 (IL-6), C-reactive protein (CRP), cortisol, and lymphocyte subpopulations (CD4/CD8) were measured repeatedly. Postoperative recovery was indicated by return of bowel function and postoperative hospital stay.


RESULTS
Patient characteristics were not different between the three groups. There were three conversions in each laparoscopy group, making conversion rates 15% and 15.7% for Laparo-V and CO(2) pneumoperitoneum groups, respectively. Vital signs remained stable in Laparo-V and open surgery groups; while, elevated ET-CO(2) and heart rate were noted in CO(2) pneumoperitoneum group. Both laparoscopy groups had a significant faster recovery and shorter hospital stay than the open surgery group. Postoperative elevation of IL-6, CRP, and cortisol level was observed in all the three groups, of note, the change was most significant in the open surgery group.


CONCLUSIONS
Laparo-V gasless laparoscopic approach is feasible in various colorectal procedures. It carries advantages comparable with those of CO(2) pneumoperitoneum; while, the intra-operative hemodynamic was more stable. Therefore, laparoscopic approach using the Laparo-V system could be beneficial to patients with high cardiopulmonary risk and represents an alternative for minimally invasive surgery.
Jiang
Jeng-Kai
JK
Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China. jkjiang@vghtpe.gov.tw
Chen
Wei-Shone
WS
Wang
Shyh-Jen
SJ
Lin
Jen-Kou
JK
D002097:C-Reactive Protein / Q000378:metabolism; D016516:CD4-CD8 Ratio; D002245:Carbon Dioxide / Q000627:therapeutic use*; D003107:Colorectal Surgery / Q000379:methods*; D003710:Demography; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy; D017770:Lifting; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016343:Monitoring, Intraoperative; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011446:Prospective Studies; D013315:Stress, Psychological / Q000097:blood / Q000150:complications
D015850:Interleukin-6; D002245:Carbon Dioxide; D002097:C-Reactive Protein; D006854:Hydrocortisone
Dis Colon Rectum. 1999 Jul;42(7):868-75; discussion 875-6
10411432
Surg Endosc. 2002 Feb;16(2):313-6
11967686
Arch Surg. 1997 Feb;132(2):166-8; discussion 169
9041921
Surg Endosc. 1992 Jul-Aug;6(4):197-8
1387738
Surg Endosc. 2000 Sep;14(9):817-9
11000360
Br J Surg. 2001 Oct;88(10):1296-306
11578282
Surg Endosc. 2001 May;15(5):477-83
11353965
Arch Surg. 1993 Oct;128(10):1102-7
8215870
Surg Endosc. 1998 Feb;12(2):107-14
9479722
Br J Anaesth. 1993 Jun;70(6):681-3
8329262
J Surg Res. 1995 Jan;58(1):75-80
7830409
Lancet. 2005 May 14-20;365(9472):1718-26
15894098
Surg Endosc. 2001 Mar;15(3):314-8
11344436
Br J Surg. 2002 Jan;89(1):35-9
11851660
Surg Endosc. 2004 Jul;18(7):1022-8
15136930
Surg Endosc. 1999 Apr;13(4):365-70
10094749
Surg Endosc. 2001 Jun;15(6):597-9
11591949
World J Surg. 2002 Mar;26(3):377-83
11865378
Surg Endosc. 2000 Nov;14(11):1062-6
11116420
Br J Surg. 2006 Aug;93(8):921-8
16845692
Surgery. 1997 Jan;121(1):72-8
9001554
Surg Gynecol Obstet. 1992 Dec;175(6):535-8
1448734
Dis Colon Rectum. 2003 Feb;46(2):147-55
12576886
Dig Surg. 1998;15(2):124-34
9845574
N Engl J Med. 2004 May 13;350(20):2050-9
15141043
Dis Colon Rectum. 1998 Jul;41(7):901-9
9678378
Lancet. 2004 Apr 10;363(9416):1187-92
15081650
Lancet. 2002 Jun 29;359(9325):2224-9
12103285
Surg Endosc. 2001 Oct;15(10):1093-7
11727077
JAMA. 2002 Jan 16;287(3):321-8
11790211
Surg Endosc. 2002 Mar;16(3):533-6
11928043
Surgery. 1998 Nov;124(5):831-8
9823395
J Nippon Med Sch. 2005 Aug;72(4):213-6
16113491
Ann Surg. 2008 Nov;248(5):728-38
18948799
Surg Endosc. 1998 Aug;12(8):1039-42
9685538
Surg Endosc. 1998 May;12(5):427-31
9569363
Surg Laparosc Endosc. 1992 Mar;2(1):11-4
1341494
J Am Coll Surg. 1997 May;184(5):506-12
9145072
Eur J Surg. 2000 Jun;166(6):467-71
10890543
Surg Endosc. 2003 Jun;17(6):899-902
12618933
Surg Endosc. 2001 Jun;15(6):600-8
11591950
J Reprod Med. 1997 May;42(5):255-9
9172113
J Clin Anesth. 1999 Aug;11(5):406-12
10526812