A novel lifting system for minimally accessed surgery: a prospective comparison between "Laparo-V" gasless and CO2 pneumoperitoneum laparoscopic colorectal surgery

作者：Jiang Jeng Kai^*; Chen Wei Shone; Wang Shyh Jen; Lin Jen Kou

来源：International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery, 2010, 25(8): 997-1004.

DOI：10.1007/s00384-010-0942-5

• Gasless laparoscopy
• Laparo-V
• Lifting devices
• Carbon dioxide pneumoperitoneum
• Colorectal surgery
• Minimal access surgery

Carbon dioxide (CO2) pneumoperitoneum can lead to cardiopulmonary loading and complications. By comparing with conventional CO2 pneumoperitoneum approach, we introduce a novel Laparo-V lifting system for gasless laparoscopic colorectal surgery.
In a prospective study, patients with colonic lesions underwent either Laparo-V gasless (n = 20) or conventional CO2 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 CO2 (ET-CO2). 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.
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 CO2 pneumoperitoneum groups, respectively. Vital signs remained stable in Laparo-V and open surgery groups; while, elevated ET-CO2 and heart rate were noted in CO2 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.
Laparo-V gasless laparoscopic approach is feasible in various colorectal procedures. It carries advantages comparable with those of CO2 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.

• 出版日期2010-8