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

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.