title: Low pressure gynecological laparoscopy (7mmHg) with AirSeal®System versus a standard insufflation (15mmHg): A pilot study in 60 patients.
abstract: OBJECTIVE
  To evaluate feasibility of performing benign gynecologic pathology low pressure (7mmHg) laparoscopy (LPL) with AirSeal®system and to study benefits in terms of postoperative pain, when compared to a standard insufflation group (15mmHg).
  
  
  METHODS
  In this prospective randomized pilot study, 60 patients had laparoscopy for gynecologic benign pathology: 30 with 7mmHg and AirSeal system, and 30 with 15mmHg standard insufflator. The primary endpoint was incidence of shoulder pain. A postoperative questionnaire was completed by each patient to assess shoulder pain (Numeric Rating Scale [NRS], from 0 to 10) at H4, H8, H24, and consumption of morphinics was notified. During each procedure, anesthesia parameters were collected (peak airway pressure, systolic blood pressure, end tidal CO2).
  
  
  RESULTS
  Laparoscopy was performed on 30 patients in AirSeal®-LP group without need to increase pressure above 7mmHg, and no complication was reported. Incidence of shoulder pain was significantly lower in the AirSeal®-LP group (23.3% vs. 73.3%, P<0.001). NRS shoulder pain was significantly lower in AirSeal®LP group at hour 4, 8 and 24. Maximal values of ETCO2, systolic blood pressure, and peak airway pressure were significantly lower in AirSeal®-LP group.
  
  
  CONCLUSIONS
  LP (7mmHg) laparoscopy with AirSeal®platform allows laparoscopic surgery with less postoperative shoulder pain. These results could facilitate the development of ambulatory laparoscopy.
authors.affiliation: Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Department of Gynecology and Obstetrics, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France. Electronic address: jeremy.sroussi@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Sroussi
authors.affiliation: Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Department of Gynecology and Obstetrics, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Elies
authors.affiliation: Department of Anesthesiology and Intensive Care, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Rigouzzo
authors.affiliation: Department of Anesthesiology and Intensive Care, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Louvet
authors.affiliation: Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Department of Gynecology and Obstetrics, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Mezzadri
authors.affiliation: Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Fazel
authors.affiliation: Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Department of Gynecology and Obstetrics, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Benifla
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000592:standards; D006801:Humans; D007327:Insufflation / Q000009:adverse effects / Q000379:methods / Q000592:standards; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000592:standards; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D010865:Pilot Projects; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000379:methods* / Q000592:standards*; D011312:Pressure; D020069:Shoulder Pain / Q000209:etiology; D059039:Standard of Care; D055815:Young Adult
keywords: AirSeal(®); Laparoscopy; Low pressure; Pneumoperitoneum; Shoulder pain