title: Small-Incision Laparoscopy-Assisted Surgery Under Abdominal Cavity Irrigation in a Porcine Model.
abstract: BACKGROUND
  Laparoscopic and robot-assisted surgeries are performed under carbon dioxide insufflation. Switching from gas to an isotonic irrigant introduces several benefits and avoids some adverse effects of gas insufflation. We developed an irrigating device and apparatus designed for single-incision laparoscopic surgery and tested its advantages and drawbacks during surgery in a porcine model.
  
  
  METHODS
  Six pigs underwent surgical procedures under general anesthesia. A 30-cm extracorporeal cistern was placed over a 5-6-cm abdominal incision. The abdomen was irrigated with warm saline that was drained via a suction tube placed near the surgical field and continuously recirculated through a closed circuit equipped with a hemodialyzer as a filter. Irrigant samples from two pigs were cultured to check for bacterial and fungal contamination. Body weight was measured before and after surgery in four pigs that had not received treatments affecting hemodynamics or causing diuresis.
  
  
  RESULTS
  One-way flow of irrigant ensured laparoscopic vision by rinsing blood from the surgical field. Through a retroperitoneal approach, cystoprostatectomy was successfully performed in three pigs, nephrectomy in two, renal excision in two, and partial nephrectomy in one, under simultaneous ultrasonographic monitoring. Through a transperitoneal approach, liver excision and hemostasis with a bipolar sealing device were performed in three pigs, and bladder pedicle excision was performed in one pig. Bacterial and fungal contamination of the irrigant was observed on the draining side of the circuit, but the filter captured the contaminants. Body weight increased by a median of 2.1% (range, 1.2-4.4%) of initial weight after 3-5 hours of irrigation.
  
  
  CONCLUSIONS
  Surgery under irrigation is feasible and practical when performed via a cistern through a small abdominal incision. This method is advantageous, especially in the enabling of continuous and free-angle ultrasound observation of parenchymal organs. Adverse effects of abdominal irrigation need further assessment before use in humans.
authors.affiliation: 1 Center for Frontier Medical Engineering, Chiba University , Chiba, Japan .
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Igarashi
authors.affiliation: 1 Center for Frontier Medical Engineering, Chiba University , Chiba, Japan .
authors.forename: Takuro
authors.initials: T
authors.lastname: Ishii
authors.affiliation: 2 Department of Anesthesiology, Asahi General Hospital , Asahi, Japan .
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Aoe
authors.affiliation: 1 Center for Frontier Medical Engineering, Chiba University , Chiba, Japan .
authors.forename: Wen-Wei
authors.initials: WW
authors.lastname: Yu
authors.affiliation: 3 Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine , Sapporo, Japan .
authors.forename: Yuma
authors.initials: Y
authors.lastname: Ebihara
authors.affiliation: 1 Center for Frontier Medical Engineering, Chiba University , Chiba, Japan .
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawahira
authors.affiliation: 4 Department of Anesthesiology, Graduate School of Medicine, Chiba University , Chiba, Japan .
authors.forename: Shiro
authors.initials: S
authors.lastname: Isono
authors.affiliation: 5 Department of Urology, Teikyo University Medical Center , Ichihara City, Japan .
authors.forename: Yukio
authors.initials: Y
authors.lastname: Naya
mesh_terms: D000818:Animals; D010535:Laparoscopy / Q000379:methods*; D023421:Models, Animal; D010533:Peritoneal Lavage / Q000379:methods*; D012965:Sodium Chloride / Q000008:administration & dosage; D013047:Specific Pathogen-Free Organisms; D013552:Swine
chemical_list: D012965:Sodium Chloride