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Published in: Surgical Endoscopy 6/2007

01-06-2007

Comparison of intraabdominal pressures using the gastroscope and laparoscope for transgastric surgery

Authors: O. Meireles, S. V. Kantsevoy, A. N. Kalloo, S. B. Jagannath, S. A. Giday, P. Magno, S. P. Shih, E. J. Hanly, C. -W. Ko, D. M. Beitler, M. R. Marohn

Published in: Surgical Endoscopy | Issue 6/2007

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Abstract

Background

The peroral transgastric endoscopic approach for intraabdominal procedures appears to be feasible, although multiple aspects of this approach remain unclear. This study aimed to measure intraperitoneal pressure in a porcine model during the peroral transgastric endoscopic approach, comparing an endoscopic on-demand insufflator/light source with a standard autoregulated laparoscopic insufflator.

Methods

All experiments were performed with 50-kg female pigs under general anesthesia. A standard upper endoscope was advanced perorally through a gastric wall incision into the peritoneal cavity. The peritoneal cavity was insufflated with operating room air from an endoscopic light source/insufflator. Intraperitoneal pressure was measured by three routes: (1) through the endoscope biopsy channel, (2) through a 5-mm transabdominal laparoscopic port, and (3) through a 16-gauge Veress needle inserted into the peritoneal cavity through the anterior abdominal wall. The source of insufflation alternated between on-demand manual insufflation through the endoscopic light source/insufflator using room air and a standard autoregulated laparoscopic insufflator using carbon dioxide (CO2).

Results

Six acute experiments were performed. Intraperitoneal pressure measurements showed good correlation regardless of measurement route and were independent of the type of insufflation gas, whether room air or CO2. On-demand insufflation with the endoscopic light source/insufflator resulted in a wide variation in pressures (range, 4–32 mmHg; mean, 16.0 ± 11.7). Intraabdominal pressures using a standard autoregulated laparoscopic insufflator demonstrated minimal fluctuation (range, 8–15 mmHg; mean, 11.0 ± 2.2 mmHg) around a predetermined value.

Conclusion

Use of an on-demand unregulated endoscopic light source/insufflator for translumenal surgery can cause large variation in intraperitoneal pressures and intraabdominal hypertension, leading to the risk of hemodynamic and respiratory compromise. Safety may favor well-controlled intraabdominal pressures achieved with a standard autoregulated laparoscopic insufflator.
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Metadata
Title
Comparison of intraabdominal pressures using the gastroscope and laparoscope for transgastric surgery
Authors
O. Meireles
S. V. Kantsevoy
A. N. Kalloo
S. B. Jagannath
S. A. Giday
P. Magno
S. P. Shih
E. J. Hanly
C. -W. Ko
D. M. Beitler
M. R. Marohn
Publication date
01-06-2007
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 6/2007
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-006-9167-7

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