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Technical aspects of pneumoperitoneum: Limiting factors on performance of cannulas and insufflators in laparoscopy and pelviscopy
August 1998, Vol. 5, No. 3 Supplement
The Journal of the American Association of GynecoJogic Laparoscopists
Conclusion. Uterine artery embolization is acceptable and effective management in women with symptomatic uterine fibroids. 70. Technical Aspects of Pneumoperitoneum: Limiting Factors on Performance of Cannulas and Insufflators in Laparoscopy and Pelviscopy 1VR Jacobs, 2D Harder, 3JE Morrison Jr, 4L Mettler, 4W Jonat. ~Christian-Albrechts University, Kiel, Germany; 2University of GOttingen, GOttingen, Germany; 3Fayette Medical Center, Fayette, Alabama; ~University of Kiel, Kiel, Germany. Objective. To evaluate and compare CO2 gas flow and resistance of different cannulas and insufflators, and improve insuffiation performance. Measurements and Main Results'. In a laboratory model gas flow, pressure, and resistance were measured at different points in the insufflation system with newly designed computer-based data-acquisition model. Different types of Veress needles, disposable (Auto Suture, Dexide, Ethicon, Origin, Richard Allan) and reusable (HiTec, Olympus, Storz, Wolf) cannulas, and insuffiators (HiTec, Olympus, Storz) were assessed. Gas flow differences between Veress needles (0.85-2.38 L/min) and disposable (3.91-9.61 L/min) and reusable (5.27-21.07 L/min) cannulas at 12 mm Hg were found depending on smallest diameter, usually at insufflation supply. Optic insertion further decrease gas flow (1.5 L/min). Insuffiator function was limited by resistance, leakage, maximum flow, and cannula type. By introducing reference values, insufflation properties of all components were comparably characterized. Conclusion. Components with larger diameters are most useful, deliver the most gas, and save time and money. Insuffiator efficiency can be increased with flow-optimized cannulas. Manufacturers should publish comparable reference values about specific flow and resistance properties of their products.
pelviscopic procedures with different insuffiators (BEI, Snowden & Pencer, Storz, Wolf) and body temperature-maintaining devices (Bair Hugger, fluid warmer, Blanketrol, blankets). Measurements and Main Results. Standard laparoscopic and pelviscopic procedures were performed in 55 women (age range 18-92 yrs). Carbon dioxide was at room temperature in the insuffiation hose (N22~ C). During insufflation, intraabdominal gas temperature decreased to 27.7 ~ C (average 32.7 ~ C) depending on length of operation (23 min-5 hrs 8 min), amount of gas used (12.8-801 L), high flow (up to -20 L/min), and leakage rate. However, insuffiator comparison before and after surgery showed no decline in rectal temperature (average +0.2 ~ C) because warming equipment was sufficient. Conclusion. Intraoperative intraabdominal gas temperature decrease is remarkable but can be limited by restricting gas flow and leakage. In operations longer than 1 hour, body temperature should be maintained with appropriate heating devices. Heating insufflated gas (Snowden & Pencer) had no significant clinical effect. 72. Laparoscopic Hysterectomy JB Jaenisch. Mae de Deus Hospital, Porto Alegre, Brazil. Objective. To describe my experience performing TLH. Measurements and Main Results. Between April 1994 and December 1997 I performed 120 TLHs. Indications for surgery were chronic menometrorrhagia, enlarged uterus, and chronic pelvic pain. Operating times ranged from 75 to 180 minutes with bipolar and Endo GIA staples. Mean hospital stay was 36 hours. Complications were two vesicovaginal fistulas, one rectovaginal fistula, and two vaginal infections. Conclusion. Laparoscopic hysterectomy can be performed by a surgeon who has appropriate training in vaginal and general surgery.
71. Intraoperative Measurements on Laparoscopic and Pelviscopic Hypothermia: How Cold Does It Get and How to Prevent It 1VR Jacobs, 2jE Morrison Jr, 3L Mettler, 3W Jonat. ~Christian-Albrechts University, Kiel, Germany; 2Fayette Medical Center, Fayette, Alabama; 3University of Kiel, Kiel, Germany.
73. Laparoscopic Treatment of Urinary Stress Incontinence JB Jaenisch. Mae de Deus Hospital, Porto Alegre, Brazil. Objective. To describe a technique for treating GUSI. Measurements and Main Results. From August 1995 to December 1997 I treated 26 women (age range
Objective. To evaluate intraabdominal CO2 gas temperature during a variety of standard laparoscopic and
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The Journal of the American Association of GynecoJogic Laparoscopists
Conclusion. Uterine artery embolization is acceptable and effective management in women with symptomatic uterine fibroids. 70. Technical Aspects of Pneumoperitoneum: Limiting Factors on Performance of Cannulas and Insufflators in Laparoscopy and Pelviscopy 1VR Jacobs, 2D Harder, 3JE Morrison Jr, 4L Mettler, 4W Jonat. ~Christian-Albrechts University, Kiel, Germany; 2University of GOttingen, GOttingen, Germany; 3Fayette Medical Center, Fayette, Alabama; ~University of Kiel, Kiel, Germany. Objective. To evaluate and compare CO2 gas flow and resistance of different cannulas and insufflators, and improve insuffiation performance. Measurements and Main Results'. In a laboratory model gas flow, pressure, and resistance were measured at different points in the insufflation system with newly designed computer-based data-acquisition model. Different types of Veress needles, disposable (Auto Suture, Dexide, Ethicon, Origin, Richard Allan) and reusable (HiTec, Olympus, Storz, Wolf) cannulas, and insuffiators (HiTec, Olympus, Storz) were assessed. Gas flow differences between Veress needles (0.85-2.38 L/min) and disposable (3.91-9.61 L/min) and reusable (5.27-21.07 L/min) cannulas at 12 mm Hg were found depending on smallest diameter, usually at insufflation supply. Optic insertion further decrease gas flow (1.5 L/min). Insuffiator function was limited by resistance, leakage, maximum flow, and cannula type. By introducing reference values, insufflation properties of all components were comparably characterized. Conclusion. Components with larger diameters are most useful, deliver the most gas, and save time and money. Insuffiator efficiency can be increased with flow-optimized cannulas. Manufacturers should publish comparable reference values about specific flow and resistance properties of their products.
pelviscopic procedures with different insuffiators (BEI, Snowden & Pencer, Storz, Wolf) and body temperature-maintaining devices (Bair Hugger, fluid warmer, Blanketrol, blankets). Measurements and Main Results. Standard laparoscopic and pelviscopic procedures were performed in 55 women (age range 18-92 yrs). Carbon dioxide was at room temperature in the insuffiation hose (N22~ C). During insufflation, intraabdominal gas temperature decreased to 27.7 ~ C (average 32.7 ~ C) depending on length of operation (23 min-5 hrs 8 min), amount of gas used (12.8-801 L), high flow (up to -20 L/min), and leakage rate. However, insuffiator comparison before and after surgery showed no decline in rectal temperature (average +0.2 ~ C) because warming equipment was sufficient. Conclusion. Intraoperative intraabdominal gas temperature decrease is remarkable but can be limited by restricting gas flow and leakage. In operations longer than 1 hour, body temperature should be maintained with appropriate heating devices. Heating insufflated gas (Snowden & Pencer) had no significant clinical effect. 72. Laparoscopic Hysterectomy JB Jaenisch. Mae de Deus Hospital, Porto Alegre, Brazil. Objective. To describe my experience performing TLH. Measurements and Main Results. Between April 1994 and December 1997 I performed 120 TLHs. Indications for surgery were chronic menometrorrhagia, enlarged uterus, and chronic pelvic pain. Operating times ranged from 75 to 180 minutes with bipolar and Endo GIA staples. Mean hospital stay was 36 hours. Complications were two vesicovaginal fistulas, one rectovaginal fistula, and two vaginal infections. Conclusion. Laparoscopic hysterectomy can be performed by a surgeon who has appropriate training in vaginal and general surgery.
71. Intraoperative Measurements on Laparoscopic and Pelviscopic Hypothermia: How Cold Does It Get and How to Prevent It 1VR Jacobs, 2jE Morrison Jr, 3L Mettler, 3W Jonat. ~Christian-Albrechts University, Kiel, Germany; 2Fayette Medical Center, Fayette, Alabama; 3University of Kiel, Kiel, Germany.
73. Laparoscopic Treatment of Urinary Stress Incontinence JB Jaenisch. Mae de Deus Hospital, Porto Alegre, Brazil. Objective. To describe a technique for treating GUSI. Measurements and Main Results. From August 1995 to December 1997 I treated 26 women (age range
Objective. To evaluate intraabdominal CO2 gas temperature during a variety of standard laparoscopic and
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