title: Use of the valveless trocar system reduces carbon dioxide absorption during laparoscopy when compared with standard trocars.
abstract: OBJECTIVE
  To prospectively compare a novel type of valveless trocar that creates a curtain of pressurized carbon dioxide [CO(2)] gas (which maintains pneumoperitoneum at a lower gas flow rate) with standard trocars; to quantify the volume of CO(2) used; and to characterize CO(2) elimination during laparoscopic renal surgery.
  
  
  METHODS
  A total of 51 patients undergoing laparoscopic renal surgery by a single surgeon were prospectively evaluated using either the valveless trocar (n = 26) or standard trocars (n = 25). Patient demographics, operative time, volume of CO(2) gas consumed, CO(2) elimination, perioperative parameters, and postoperative complications were recorded and analyzed.
  
  
  RESULTS
  Both patient cohorts were comparable in their preoperative demographics, including body mass index, the number of patients with chronic obstructive pulmonary disease, and smoking history. Mean operative time was lower in the valveless trocar cohort (124.1 minutes) compared with the conventional trocar group (145.6 minutes), P = .047. Use of the valveless trocar was associated with a lower volume of intraoperative CO(2) consumed (120.0 ± 82.8 vs 300.6 ± 191.5; P < .001) and reduced CO(2) elimination compared with standard trocar use after the first 16 minutes of insufflation (P < .05). Minimal complications occurred, including 2 cases of subcutaneous emphysema in the valveless trocar group, and 1 case of respiratory acidosis in the conventional trocar group.
  
  
  CONCLUSIONS
  Use of a valveless trocar significantly reduced CO(2) consumption during transperitoneal laparoscopy. The valveless trocar also demonstrated significantly reduced CO(2) elimination and absorption when compared with the standard trocar.
authors.affiliation: Arthur Smith Institute for Urology, North Shore–Long Island Jewish Health System, Hofstra University School of Medicine, New Hyde Park, New York 11040, USA.
authors.forename: Amin S
authors.initials: AS
authors.lastname: Herati
authors.forename: Sero
authors.initials: S
authors.lastname: Andonian
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Atalla
authors.forename: Arun K
authors.initials: AK
authors.lastname: Srinivasan
authors.forename: Lee
authors.initials: L
authors.lastname: Richstone
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000378:metabolism*; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide