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

Abstract

Purpose: Carbon dioxide (CO(2)) pneumoperitoneum can lead to cardiopulmonary loading and complications. By comparing with conventional CO(2) pneumoperitoneum approach, we introduce a novel Laparo-V lifting system for gasless laparoscopic colorectal surgery.

Methods: In a prospective study, patients with colonic lesions underwent either Laparo-V gasless (n = 20) or conventional CO(2) 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 CO(2) (ET-CO(2)). 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.

Results: 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 CO(2) pneumoperitoneum groups, respectively. Vital signs remained stable in Laparo-V and open surgery groups; while, elevated ET-CO(2) and heart rate were noted in CO(2) 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.

Conclusions: Laparo-V gasless laparoscopic approach is feasible in various colorectal procedures. It carries advantages comparable with those of CO(2) 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.