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Use of the Valveless Trocar System Reduces Carbon Dioxide Absorption During Laparoscopy When Compared With Standard Trocars

  • Amin S. Herati
    Affiliations
    Arthur Smith Institute for Urology, North Shore–Long Island Jewish Health System, Hofstra University School of Medicine, New Hyde Park, New York
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  • Sero Andonian
    Affiliations
    Arthur Smith Institute for Urology, North Shore–Long Island Jewish Health System, Hofstra University School of Medicine, New Hyde Park, New York
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  • Soroush Rais-Bahrami
    Affiliations
    Arthur Smith Institute for Urology, North Shore–Long Island Jewish Health System, Hofstra University School of Medicine, New Hyde Park, New York
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  • Mohamed A. Atalla
    Affiliations
    Arthur Smith Institute for Urology, North Shore–Long Island Jewish Health System, Hofstra University School of Medicine, New Hyde Park, New York
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  • Arun K. Srinivasan
    Affiliations
    Arthur Smith Institute for Urology, North Shore–Long Island Jewish Health System, Hofstra University School of Medicine, New Hyde Park, New York
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  • Lee Richstone
    Affiliations
    Arthur Smith Institute for Urology, North Shore–Long Island Jewish Health System, Hofstra University School of Medicine, New Hyde Park, New York
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  • Louis R. Kavoussi
    Correspondence
    Reprint requests: Louis R. Kavoussi, M.D., Arthur Smith Institute for Urology, North Shore–Long Island Jewish Health System, Hofstra University School of Medicine, 450 Lakeville Road, Suite M-41, New Hyde Park, NY 11040
    Affiliations
    Arthur Smith Institute for Urology, North Shore–Long Island Jewish Health System, Hofstra University School of Medicine, New Hyde Park, New York
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Published:October 01, 2010DOI:https://doi.org/10.1016/j.urology.2010.06.052

      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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