Impact of pneumoperitoneum on intra-abdominal microcirculation blood flow: an experimental randomized controlled study o
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and Other Interventional Techniques
Impact of pneumoperitoneum on intra‑abdominal microcirculation blood flow: an experimental randomized controlled study of two insufflator models during transanal total mesorectal excision An experimental randomized multi-arm trial with parallel treatment design F. Borja de Lacy1 · Pilar Taurà2 · María Clara Arroyave3 · Jean‑Sébastien Trépanier4 · José Ríos5,6 · Raquel Bravo1 · Ainitze Ibarzabal1 · Romina Pena1 · Ramon Deulofeu7 · Antonio M. Lacy8 Received: 8 June 2019 / Accepted: 28 October 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Objective To compare changes in microcirculation blood flow (MCBF) between pulsatile and continuous flow insufflation. Summary background data Transanal total mesorectal excision (TaTME) was developed to improve the quality of the resection in rectal cancer surgery. The AirSeal IFS® insufflator facilitates the pelvic dissection, although evidence on the effects that continuous flow insufflation has on MCBF is scarce. Methods Thirty-two pigs were randomly assigned to undergo a two-team TaTME procedure with continuous (n = 16) or pulsatile insufflation (n = 16). Each group was stratified according to two different pressure levels in both the abdominal and the transanal fields, 10 mmHg or 14 mmHg. A generalized estimating equations (GEE) model was used. Results At an intra-abdominal pressure (IAP) of 10 mmHg, continuous insufflation was associated with a significantly lower MCBF reduction in colon mucosa [13% (IQR 11;14) vs. 21% (IQR 17;24) at 60 min], colon serosa [14% (IQR 9.2;18) vs. 25% (IQR 22;30) at 60 min], jejunal mucosa [13% (IQR 11;14) vs. 20% (IQR 20;22) at 60 min], renal cortex [18% (IQR 15;20) vs. 26% (IQR 26;29) at 60 min], and renal medulla [15% (IQR 11;20) vs. 20% (IQR 19;21) at 90 min]. At an IAP of 14 mmHg, MCBF in colon mucosa decreased 23% (IQR 14;27) in the continuous group and 28% (IQR 26;31) in the pulsatile group (p = 0.034). Conclusion TaTME using continuous flow insufflation was associated with a lower MCBF reduction in colon mucosa and serosa, jejunal mucosa, renal cortex, and renal medulla compared to pulsatile insufflation. Keywords Transanal total mesorectal excision · Randomized controlled trial · Continuous insufflation · Colored microspheres The transanal total mesorectal excision (TaTME) assisted by laparoscopy was developed for the treatment of rectal cancer [1]. TaTME can be performed either via one-team or two-teams approach, the latest decreasing operative time [2]. This technique allows for an easier pelvic dissection and has
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-019-07236-5) contains supplementary material, which is available to authorized users. * F. Borja de Lacy [email protected] Extended author information available on the last page of the article
been accepted by the surgical community due to its potential of increasing the quality of the specimen [1]. Laparoscopy is based on the insuffla
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