Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec;38(12):7426-7434.
doi: 10.1007/s00464-024-11338-0. Epub 2024 Oct 24.

Surgical conditions in experimental laparoscopy: effects of pressure, neuromuscular blockade, and pre-stretching on workspace volume

F Sterke #  1   2 , W van Weteringen #  3   4 , P A van der Zee  3 , J van Rosmalen  5   6 , R M H Wijnen  3 , J Vlot  3
Affiliations

Surgical conditions in experimental laparoscopy: effects of pressure, neuromuscular blockade, and pre-stretching on workspace volume

F Sterke et al. Surg Endosc. 2024 Dec.

Abstract

Background: Establishing a pneumoperitoneum for laparoscopy is common surgical practice, with the goal to create an optimal surgical workspace within the abdominal cavity while minimizing insufflation pressure. Individualized strategies, based on neuromuscular blockade (NMB), pre-stretching routines, and personalized intra-abdominal pressure (IAP) to enhance surgical conditions are strategies to improve surgical workspace. However, the specific impact of each factor remains uncertain. This study explores the effects and side-effects of modifying intra-abdominal volume (IAV) through moderate and complete NMB in a porcine laparoscopy model.

Methods: Thirty female Landrace pigs were randomly assigned to groups with complete NMB, regular NMB and a control group. Varying IAP levels were applied, and IAV was measured using CT scans. The study evaluated the maximum attainable IAV (Vmax), the pressure at which the cavity opens (p0), and the ease of expansion (λexp). Cardiorespiratory parameters, including peak inspiratory pressure (PIP), mean arterial pressure (MAP), heart rate (HR), and cardiac output (CO), were continuously recorded to evaluate side-effects.

Results: There were no significant weight differences between NMB groups (median 21.1 kg). Observed volumes ranged from 0 to 4.7 L, with a mean Vmax of 3.82 L, mean p0 of 1.23 mmHg, and mean λexp of 0.13 hPa-1. NMB depth did not significantly affect these parameters. HR was significantly increased in the complete NMB group, while PIP, MAP, and CO remained unaffected. Repeated insufflation positively impacted Vmax; ease of opening; and expanding the cavity.

Conclusion: In this porcine model, the depth of NMB does not alter abdominal mechanics or increase the surgical workspace. Cardiorespiratory changes are more related to insufflation pressure and frequency rather than NMB depth. Future studies should compensate for the positive effect of repeated insufflation on abdominal mechanics and surgical conditions.

Keywords: Insufflation; Neuromuscular blockade; Surgical workspace.

PubMed Disclaimer

Conflict of interest statement

Disclosures: Erasmus MC received partial funding from Health ~ Holland (LSHM17063) and Merck Sharp & Dohme Corp (ISS57163). Erasmus MC holds patents on improved insufflation devices, with Willem van Weteringen, John Vlot, and Frank Sterke as inventors. John Vlot received an insufflation device from Karl Storz SE & Co. KG. Willem van Weteringen and Frank Sterke are partially employed by an Erasmus MC spin-off developing an enhanced insufflator. Philip van der Zee, Joost van Rosmalen, and René Wijnen have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Abdominal pressure–volume curves in three different subjects (▲, ●, and ■) and estimated parameters. The corresponding models (–) are extrapolated to provide a visual explanation. Vmax relates to the horizontal asymptote and p0 relates to the location on the horizontal axis when the volume equals zero. The curvature is described by λexp
Fig. 2
Fig. 2
Abdominal pressure–volume curve, the effect of neuromuscular blockade and repeated insufflation, the estimated marginal means, and 95% confidence intervals based on the variation between animals. a The maximum intra-abdominal volume in L. b The opening pressure p0 in hPa. c The pressure expansion coefficient, λ in hPa−1
Fig. 3
Fig. 3
Circulation, the effect of insufflation pressure on mean arterial pressure, heart rate, and cardiac output. The graphs shows the estimated marginal means and 95% confidence interval based on the variation between animals. The columns sort the effect per group, the rows show the change of effect per insufflation run
See this image and copyright information in PMC

References

    1. Neugebauer EA, Sauerland S, Fingerhut A, Millat B, Buess G (2006) EAES guidelines for endoscopic surgery. Springer, Berlin
    1. Özdemir-van Brunschot DMD, van Laarhoven KCJHM, Scheffer GJ, Pouwels S, Wever KE, Warlé MC (2016) What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review. Surg Endosc 30:2049–2065. 10.1007/S00464-015-4454-9 - PMC - PubMed
    1. Díaz-Cambronero O, Mazzinari G, Flor Lorente B, García Gregorio N, Robles-Hernandez D, Olmedilla Arnal LE, Martin de Pablos A, Schultz MJ, Errando CL, Argente Navarro MP (2020) Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery. Br J Surg 107:1605–1614. 10.1002/bjs.11736 - PubMed
    1. Fuchs-Buder T, De Robertis E, Brunaud L (2018) Neuromuscular block in laparoscopic surgery. Minerva Anestesiol 84:509–514. 10.23736/S0375-9393.17.12330-8 - PubMed
    1. Madsen MV, Staehr-Rye AK, Gätke MR, Claudius C (2015) Neuromuscular blockade for optimising surgical conditions during abdominal and gynaecological surgery: a systematic review. Acta Anaesthesiol Scand 59:1–16. 10.1111/aas.12419 - PubMed

LinkOut - more resources