Effects of elevated artificial pneumoperitoneum pressure on invasive blood pressure and levels of blood gases

Impact of low-pressure pneumoperitoneum and deep neuromuscular blockade on surgeon satisfaction and patient outcomes in laparoscopic cholecystectomy patients: A prospective randomised controlled study

INTRODUCTION

The impact of laparoscopic surgery on homeostatic systems necessitates careful consideration of intra-abdominal pressure (IAP) management. This study investigated the effects of low-pressure pneumoperitoneum with deep neuromuscular blockade (NMB) on surgeon satisfaction, haemodynamics and post-operative outcomes in laparoscopic cholecystectomy patients.

PATIENTS AND METHODS

The study design involves prospective randomised control. Ninety patients were assigned to low (7-10 mmHg, n = 45) or normal (12-16 mmHg, n = 45) IAP groups. Deep NMB, guided by train-of-four monitoring, was administered. This study evaluated surgical rating scale scores, haemodynamics and post-operative outcomes through a literature review. A computer programme (IBM, SPSS) was used for statistical analysis. Chi-square and Mann-Whitney U tests were used to analyse patients' IAP levels, additional NMB requirements, surgical rating scale scores and numerical rating scales. Patient demographics and other intraoperative and post-operative variables were analysed with Student's t -test and the Mann-Whitney U test. Values of P < 0.05 were considered to indicate statistical significance.

RESULTS

No significant demographic differences were observed. The low-pressure group exhibited lower post-operative pain ( P < 0.01) and reduced analgesia requirements ( P = 0.00). On analysis of the surgeon rating scale, no disparities were evident between the groups. NMB usage correlated with height and weight ( P < 0.01). Heart rate showed no intergroup differences. The MAP measured after 15 min was lower in Group L, and the difference was significant ( P = 0.023). The SAP measured after 30 min was lower in Group L, and the difference was significant ( P = 0.017). Blood gas values and surgical field visibility were unaffected by the IAP. The positive correlations between NMB, height and weight aligned with previous research.

CONCLUSION

This study highlights successful laparoscopic cholecystectomy under low IAP, deep NMB and favourable post-operative outcomes. Despite these limitations, the findings contribute to optimising laparoscopic surgical approaches.

KeyLoop: Mechanical Retraction of the Abdominal Wall for Gasless Laparoscopy

Background. Despite favorable outcomes of laparoscopic surgery in high-income countries, its implementation in low- and middle-income countries (LMICs) is challenging given a shortage of consumable supplies, high cost, and risk of power outages. To overcome these barriers, we designed a mechanical retractor that provides vertical tension on the anterior abdominal wall. Methods. The retractor design is anatomically and mathematically optimized to provide exposure similar to traditional gas-based insufflation methods. Anatomical data from computed tomography scans were used to define retractor size. The retractor is constructed of biocompatible stainless steel rods and paired with a table-mounted lifting system to provide 5 degrees of freedom. Structural integrity was assessed through finite element analysis (FEA) and load testing. Functional testing was performed in a laparotomy model. Results. A user guide based on patient height and weight was created to customize retractor size, and 4 retractor sizes were constructed. FEA data using a 13.6 kg mass (15 mm Hg pneumoperitoneum) show a maximum of 30 mm displacement with no permanent deformation. Physical load testing with applied weight from 0 to 13.6 kg shows a maximum of 60 mm displacement, again without permanent deformation. Retraction achieved a 57% larger field of view compared to an unretracted state in a laparotomy model. Conclusions. The KeyLoop retractor maintains structural integrity, is easily sterilized, and can be readily manufactured, making it a viable alternative to traditional insufflation methods. For surgeons and patients in LMICs, the KeyLoop provides a means to increase access to laparoscopic surgery.

Laparoscopic assisted extraperitoneal hernia sac high ligation vs traditional surgery for inguinal hernia in preschool children

AIM: To compare the clinical effects of laparoscopic assisted extraperitoneal hernia sac high ligation with traditional surgery in the management of inguinal hernia in preschool children.

METHODS: Preschool children with inguinal hernia treated at Suqian People's Hospital from March 2013 to January 2015 were divided into two groups to receive either laparoscopic assisted extraperitoneal hernia sac high ligation (observation group, n = 53) or traditional surgery (control group, n = 49). Operative time, hospital stay, and postoperative complications were compared for the two groups.

RESULTS: All surgical procedures were successful in the two groups. The mean operation time and hospital stay were significantly better in the observation group than in the control group (15.35 min ± 2.11 min vs 20.45 min ± 3.74, 2.0 d vs 3.5 d, P < 0. 05). The postoperative follow-up duration was 6 mo, during which no postoperative recurrence was observed in the observation group. One case of contralateral hernia developed in patients with unilateral inguinal hernia in the observation group. In the control group, 7 cases of contralateral hernia appeared.

CONCLUSION: Laparoscopic assisted extraperitoneal hernia sac high ligation treatment of inguinal hernia in preschool children is feasible and convenient, with shorter hospital stay and fewer postoperative complications.