Sroussi J, Elies A, Rigouzzo A, Louvet N, Mezzadri M, Fazel A, Benifla J-L
Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Department of Gynecology and Obstetrics, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France.
Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Department of Gynecology and Obstetrics, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France.
J Gynecol Obstet Hum Reprod. 2017 Feb;46(2):155-158. doi: 10.1016/j.jogoh.2016.09.003. Epub 2017 Jan 30.
To evaluate feasibility of performing benign gynecologic pathology low pressure (7mmHg) laparoscopy (LPL) with AirSeal system and to study benefits in terms of postoperative pain, when compared to a standard insufflation group (15mmHg).
In this prospective randomized pilot study, 60 patients had laparoscopy for gynecologic benign pathology: 30 with 7mmHg and AirSeal system, and 30 with 15mmHg standard insufflator. The primary endpoint was incidence of shoulder pain. A postoperative questionnaire was completed by each patient to assess shoulder pain (Numeric Rating Scale [NRS], from 0 to 10) at H4, H8, H24, and consumption of morphinics was notified. During each procedure, anesthesia parameters were collected (peak airway pressure, systolic blood pressure, end tidal CO).
Laparoscopy was performed on 30 patients in AirSeal-LP group without need to increase pressure above 7mmHg, and no complication was reported. Incidence of shoulder pain was significantly lower in the AirSeal-LP group (23.3% vs. 73.3%, P<0.001). NRS shoulder pain was significantly lower in AirSeal LP group at hour 4, 8 and 24. Maximal values of ETCO, systolic blood pressure, and peak airway pressure were significantly lower in AirSeal-LP group.
LP (7mmHg) laparoscopy with AirSeal platform allows laparoscopic surgery with less postoperative shoulder pain. These results could facilitate the development of ambulatory laparoscopy.
评估使用AirSeal系统进行良性妇科病理低压（7mmHg）腹腔镜检查（LPL）的可行性，并与标准气腹组（15mmHg）相比，研究其在术后疼痛方面的益处。
在这项前瞻性随机试点研究中，60例患者因妇科良性病理接受腹腔镜检查：30例使用7mmHg及AirSeal系统，30例使用15mmHg标准气腹器。主要终点是肩部疼痛的发生率。每位患者完成一份术后问卷，以评估术后4小时、8小时、24小时的肩部疼痛（数字评分量表[NRS]，0至10分），并记录吗啡类药物的使用情况。在每个手术过程中，收集麻醉参数（气道峰压、收缩压、呼气末二氧化碳分压）。
AirSeal-LP组30例患者进行了腹腔镜检查，无需将压力提高到7mmHg以上，且未报告并发症。AirSeal-LP组肩部疼痛的发生率显著较低（23.3%对73.3%，P<0.001）。AirSeal LP组在术后4小时、8小时和24小时的NRS肩部疼痛评分显著较低。AirSeal-LP组的呼气末二氧化碳分压、收缩压和气道峰压的最大值显著较低。
使用AirSeal平台的低压（7mmHg）腹腔镜检查可使腹腔镜手术术后肩部疼痛减轻。这些结果可能有助于门诊腹腔镜检查的发展。
