Low pressure gynecological laparoscopy (7mmHg) with AirSeal® System versus a standard insufflation (15mmHg): A pilot study in 60 patients

• Published in: Journal of gynecology obstetrics and human reproduction Vol. 46; no. 2; pp. 155 - 158
• Main Authors: Sroussi, J., Elies, A., Rigouzzo, A., Louvet, N., Mezzadri, M., Fazel, A., Benifla, J.-L.
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.02.2017
• Subjects: Adult; AirSeal; Feasibility Studies; Female; Gynecologic Surgical Procedures - adverse effects; Gynecologic Surgical Procedures - methods; Gynecologic Surgical Procedures - standards; Humans; Insufflation - adverse effects; Insufflation - methods; Insufflation - standards; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Laparoscopy - standards; Low pressure; Middle Aged; Pain Measurement; Pain, Postoperative - etiology; Pilot Projects; Pneumoperitoneum; Pneumoperitoneum, Artificial - adverse effects; Pneumoperitoneum, Artificial - methods; Pneumoperitoneum, Artificial - standards; Pressure; Shoulder pain; Shoulder Pain - etiology; Standard of Care; Young Adult; AirSeal; Laparoscopy; Shoulder pain; Pneumoperitoneum; Low pressure; AirSeal(®)
• ISSN: 2468-7847; 2468-7847
• DOI: 10.1016/j.jogoh.2016.09.003

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 CO2). 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 ETCO2, 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.