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Intraoperative evaluation of laparoscopic insufflation technique for quality control in the OR.

Jacobs VR, Morrison JE, Mundhenke C, Golombeck K, Jonat W - JSLS (2000 Jul-Sep)

Bottom Line: Blood-irrigation fluids found in the hose (n=3/73) can lead to bacterial contamination.Gas temperature in the hose equals room temperature but can decrease in the abdomen to 27.7 degrees C due to high gas flow, large amounts of gas used and prolonged insufflation.Although no obvious complication related to insufflation problems occurred, some findings potentially question patient security.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Fayette Medical Center, AL 35555, USA. volkerjacobs@hotmail.com

ABSTRACT

Objective: With increasing technology and computerized systems in the OR, the physician's responsibility is growing. For intraoperative evaluation of insufflation techniques, a data acquisition model for quality control study of potential insufflation problems is necessary.

Methods: A computer-based, online data acquisition model was designed with a Pentium notebook, PCMCIA data acquisition board PCI-460-P1 and a Visual Designer 3.0 measurement program (both Intelligent Instrumentation, Inc., Tucson, AZ), temperature meters Therm 2280-1 and 2283-2 (Ahlborn, Holzkirchen, Germany) and temperature probes 401 AC and 402 AC (YSI, Inc., Yellow Springs, OH) and T-430-2R (Ahlborn, Holzkirchen, Germany). Gas flow was measured with laminar flow element LFE 1 and flow meters Digima premo 720 (both Special Instruments, Noerdlingen, Germany). During 73 standard laparoscopic procedures, gas flow (L/min) in the insufflation hose, pressure (mm Hg) in the hose and abdomen as well as temperature (degrees C) in the hose, abdomen and rectum were measured continuously at 3 Hz rate.

Results: Actual values measured show a wide range often not identical with insufflator presetting. Pressure in the abdomen is usually less than hose pressure. Intra-abdominal pressure peaks (< or = 50 mm Hg) occurred during insufficient anesthesia, while leaning on the abdomen, during trocar insertion and other manipulation. Blood-irrigation fluids found in the hose (n=3/73) can lead to bacterial contamination. Negative pressure (-50 mm Hg) was measured due to Endobag removal. Negative flow (< or = 15 L/min) was caused by pressure on the abdomen, insufflator regulation and an empty CO2 gas tank. Gas temperature in the hose equals room temperature but can decrease in the abdomen to 27.7 degrees C due to high gas flow, large amounts of gas used and prolonged insufflation. Further insufflation-related problems were documented.

Conclusions: This computer-based measurement model proved to be useful for quality control study in the OR. Results demonstrate the need for intraoperative evaluation of insufflation techniques for laparoscopy. Although no obvious complication related to insufflation problems occurred, some findings potentially question patient security.

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Insufflators evaluated (top to bottom): 1. Storz Endoflator, 2. Storz Laparoflator, 3. Snowden & Pencer, 4. BEI Medical, 5. Wolf.
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Figure 5: Insufflators evaluated (top to bottom): 1. Storz Endoflator, 2. Storz Laparoflator, 3. Snowden & Pencer, 4. BEI Medical, 5. Wolf.

Mentions: This computer model was used to evaluate different insufflators: the Karl Storz Endoflator 26012CH (flowmax 20 L/min), Karl Storz Laparoflator 26012C (10 L/min), Snowden & Pencer 89-8600 (15 L/min), BEI Medical 92000V (20 L/min) and Richard Wolf 2231 (15 L/min) (Figure 5).


Intraoperative evaluation of laparoscopic insufflation technique for quality control in the OR.

Jacobs VR, Morrison JE, Mundhenke C, Golombeck K, Jonat W - JSLS (2000 Jul-Sep)

Insufflators evaluated (top to bottom): 1. Storz Endoflator, 2. Storz Laparoflator, 3. Snowden & Pencer, 4. BEI Medical, 5. Wolf.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3021324&req=5

Figure 5: Insufflators evaluated (top to bottom): 1. Storz Endoflator, 2. Storz Laparoflator, 3. Snowden & Pencer, 4. BEI Medical, 5. Wolf.
Mentions: This computer model was used to evaluate different insufflators: the Karl Storz Endoflator 26012CH (flowmax 20 L/min), Karl Storz Laparoflator 26012C (10 L/min), Snowden & Pencer 89-8600 (15 L/min), BEI Medical 92000V (20 L/min) and Richard Wolf 2231 (15 L/min) (Figure 5).

Bottom Line: Blood-irrigation fluids found in the hose (n=3/73) can lead to bacterial contamination.Gas temperature in the hose equals room temperature but can decrease in the abdomen to 27.7 degrees C due to high gas flow, large amounts of gas used and prolonged insufflation.Although no obvious complication related to insufflation problems occurred, some findings potentially question patient security.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Fayette Medical Center, AL 35555, USA. volkerjacobs@hotmail.com

ABSTRACT

Objective: With increasing technology and computerized systems in the OR, the physician's responsibility is growing. For intraoperative evaluation of insufflation techniques, a data acquisition model for quality control study of potential insufflation problems is necessary.

Methods: A computer-based, online data acquisition model was designed with a Pentium notebook, PCMCIA data acquisition board PCI-460-P1 and a Visual Designer 3.0 measurement program (both Intelligent Instrumentation, Inc., Tucson, AZ), temperature meters Therm 2280-1 and 2283-2 (Ahlborn, Holzkirchen, Germany) and temperature probes 401 AC and 402 AC (YSI, Inc., Yellow Springs, OH) and T-430-2R (Ahlborn, Holzkirchen, Germany). Gas flow was measured with laminar flow element LFE 1 and flow meters Digima premo 720 (both Special Instruments, Noerdlingen, Germany). During 73 standard laparoscopic procedures, gas flow (L/min) in the insufflation hose, pressure (mm Hg) in the hose and abdomen as well as temperature (degrees C) in the hose, abdomen and rectum were measured continuously at 3 Hz rate.

Results: Actual values measured show a wide range often not identical with insufflator presetting. Pressure in the abdomen is usually less than hose pressure. Intra-abdominal pressure peaks (< or = 50 mm Hg) occurred during insufficient anesthesia, while leaning on the abdomen, during trocar insertion and other manipulation. Blood-irrigation fluids found in the hose (n=3/73) can lead to bacterial contamination. Negative pressure (-50 mm Hg) was measured due to Endobag removal. Negative flow (< or = 15 L/min) was caused by pressure on the abdomen, insufflator regulation and an empty CO2 gas tank. Gas temperature in the hose equals room temperature but can decrease in the abdomen to 27.7 degrees C due to high gas flow, large amounts of gas used and prolonged insufflation. Further insufflation-related problems were documented.

Conclusions: This computer-based measurement model proved to be useful for quality control study in the OR. Results demonstrate the need for intraoperative evaluation of insufflation techniques for laparoscopy. Although no obvious complication related to insufflation problems occurred, some findings potentially question patient security.

Show MeSH
Related in: MedlinePlus