title: A dual-valve system to minimize loss of pneumoperitoneum in laparoscopic surgery.
abstract: OBJECTIVE
  Loss of visualization of the surgical field due to pneumoperitoneum deflation when CO2 insufflator cylinders become empty can occur at key moments during laparoscopic surgery. The purpose of this study was to examine the incidence of intraoperative cylinder exhaustion in the United Kingdom, determine its impact on patient safety, and design and test a novel device to minimize the phenomenon.
  
  
  METHODS
  We performed a national cross-sectional survey of U.K. surgeons, inviting all members of the Association of Surgeons of Great Britain and Ireland (ASGBI) and the Association of Upper GI Surgeons (AUGIS) to participate. We designed and tested a novel dual-valve system to allow rapid intraoperative exchange of CO2 cylinders.
  
  
  RESULTS
  Eighty-five percent of the U.K. surgeons surveyed reported loss of surgical visualization at critical times during laparoscopic surgery, caused by the decrease in pneumoperitoneum during CO2 cylinder exchange. Eighty-four percent said that the process contributed to the surgeon's stress, and 63% said that a device that maintains uninterrupted pneumoperitoneum would reduce the risk of intraoperative complications. In our locale, a timed cylinder exchange was, on average, 30 times quicker with the novel dual valve than by conventional cylinder exchange (mean conventional exchange time, 61.3 ± 7.3 s vs. novel device, 2.0 ± 0.2 s; P ≤ .0001) and could be performed just as rapidly by staff unfamiliar with the device (2.2 ± 0.3 s vs. 1.9 ± 0.4 s P = .1945). We suggest that this simple, low-cost system could be developed for use in a clinical setting to enhance patient safety.
authors.affiliation: Departments of Surgery.
authors.forename: Jeyakumar Ratnam
authors.initials: JR
authors.lastname: Apollos
authors.affiliation: Anaesthesia, Dumfries & Galloway Royal Infirmary, National Health Service (NHS) Dumfries & Galloway, Dumfries, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lawrence
authors.affiliation: Departments of Surgery.
authors.forename: Rachel Victoria
authors.initials: RV
authors.lastname: Guest
mesh_terms: D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D004867:Equipment Design; D006801:Humans; D007327:Insufflation / Q000295:instrumentation*; D010535:Laparoscopy; D011028:Pneumoperitoneum, Artificial / Q000295:instrumentation*; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom
keywords: CO2 cylinder exchange; Loss of insufflation