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| Name | Class |
|---|---|
| Instituto de Investigacion Sanitaria La Fe | OTHER |
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Optimizing all factors that increase the intra-abdominal volume and performing an individualized strategy should allow us to reduce the pneumoperitoneum insufflation pressure while maintaining optimal surgery conditions for a laparoscopic colorectal surgery, compared to the standard strategy of maintaining fixed intra-abdominal insufflation pressures (12-15 mmHg).
In the context of multimodal rehabilitation in colorectal laparoscopic surgery (Fast Track or ERAS (Enhance Recovery After Surgery)) multiple strategies have been introduced that have managed to improve patient recovery, decrease postoperative complications, decrease hospital days and decrease the overall costs per process.
The possibility of performing individualized colorectal laparoscopic surgery with the minimum insufflation pressure guaranteeing optimal surgical conditions has not been evaluated and this would allow us to reduce the impact of surgery on the patient, decrease perioperative morbidity and improve patient recovery.
In our study, abdominal compliance, Pv0 and maximal Pv were determined during the initial performance of the pneumoperitoneum, and then a stepwise protocol for the reduction of intra-abdominal pressure (IAP) insufflation was stablished with evaluation by the surgeons, until reaching the minimal insufflation IAP in which optimal surgical conditions are maintained.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients | Patients undergoing laparoscopic colorectal surgery |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Laparoscopic colorectal surgery | Procedure | Minimizing intra-abdominal insufflation pressure in laparoscopic colorectal surgery as an individualized strategy |
|
| Measure | Description | Time Frame |
|---|---|---|
| Minimal intra-abdominal pressure | To obtain values of intra-abdominal pressure level of minimum insufflation that guarantees optimal surgical conditions following an individualized strategy [mmHg]. | From pneumoperitoneum induction until surgery completion (during the intraoperative period), up to 300 minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| Ventilation pattern pressure | Airway pressures at different levels of IAP (peak pressure, PEEP (positive end expiratory pressure), plateau pressure, driving pressure) [mmH2O]. | From pneumoperitoneum induction until surgery completion (during the intraoperative period), up to 300 minutes. |
| Intra-abdominal pressures (Pv0, maximal IAP) |
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Inclusion Criteria:
Exclusion Criteria:
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Patients undergoing colorectal laparoscopic surgery. Patients will be excluded of the analysis if the surgery cannot be finished by laparoscopy,
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| Name | Affiliation | Role |
|---|---|---|
| Oscar Diaz Cambronero | Physician, Specialist in Anesthesiology | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29951750 | Derived | Diaz-Cambronero O, Flor Lorente B, Mazzinari G, Vila Montanes M, Garcia Gregorio N, Robles Hernandez D, Olmedilla Arnal LE, Argente Navarro MP, Schultz MJ, Errando CL; IPPColLapSe study group. A multifaceted individualized pneumoperitoneum strategy for laparoscopic colorectal surgery: a multicenter observational feasibility study. Surg Endosc. 2019 Jan;33(1):252-260. doi: 10.1007/s00464-018-6305-y. Epub 2018 Jun 27. |
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Pv0 (IAP with volume 0) and maximal IAP [mmHg]. |
| From pneumoperitoneum induction until surgery completion (during the intraoperative period), up to 300 minutes. |
| Intra-abdominal pressures (abdominal compliance). | Dynamic abdominal compliance per liter (DV/DP, difference in volume/difference in pressure [L/mmHg]). | From pneumoperitoneum induction until surgery completion (during the intraoperative period), up to 300 minutes. |
| Surgeon skills and experience | Previous experience of the surgeon in laparoscopic surgery, annual cases, years of experience, previous experience with low IAP. | Years of experience, up to 10 years. |
| Duration of surgery | Duration of surgery in minutes from incision to abdominal wall closure. | The follow-up period will be extended during the intraoperative period, from initial incision until surgery completion, up to 300 minutes. |
| Postoperative complications | Evolution and complications in the postoperative period: Postoperative pain in the first 24 hours. Postoperative complications were assessed using the Clavier-Dindo classification. | The follow-up period will be extended until hospital discharge for the evaluation of complications, an average of 7 to 10 days. |
| Hospital stay | Hospital stay in days | The follow-up period will be extended until hospital discharge for the evaluation of complications, an average of 7 to 10 days. |