Objectives
To prospectively compare a novel type of valveless trocar that creates a curtain of
pressurized carbon dioxide [CO2] gas (which maintains pneumoperitoneum at a lower gas flow rate) with standard trocars;
to quantify the volume of CO2 used; and to characterize CO2 elimination during laparoscopic renal surgery.
Methods
A total of 51 patients undergoing laparoscopic renal surgery by a single surgeon were
prospectively evaluated using either the valveless trocar (n = 26) or standard trocars
(n = 25). Patient demographics, operative time, volume of CO2 gas consumed, CO2 elimination, perioperative parameters, and postoperative complications were recorded
and analyzed.
Results
Both patient cohorts were comparable in their preoperative demographics, including
body mass index, the number of patients with chronic obstructive pulmonary disease,
and smoking history. Mean operative time was lower in the valveless trocar cohort
(124.1 minutes) compared with the conventional trocar group (145.6 minutes), P = .047. Use of the valveless trocar was associated with a lower volume of intraoperative
CO2 consumed (120.0 ± 82.8 vs 300.6 ± 191.5; P < .001) and reduced CO2 elimination compared with standard trocar use after the first 16 minutes of insufflation
(P < .05). Minimal complications occurred, including 2 cases of subcutaneous emphysema
in the valveless trocar group, and 1 case of respiratory acidosis in the conventional
trocar group.
Conclusions
Use of a valveless trocar significantly reduced CO2 consumption during transperitoneal laparoscopy. The valveless trocar also demonstrated
significantly reduced CO2 elimination and absorption when compared with the standard trocar.
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Article info
Publication history
Published online: October 01, 2010
Accepted:
June 29,
2010
Received:
January 3,
2010
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
