Abdominal access following insufflation with Veress needle at high pressure: A security maneuver for the reduction of surgical complications during laparoscopic access

Abstract

Introduction

Up to 50% of laparoscopic complications arise during access maneuvers to abdominal cavity. Our aim is to determine whether elevated pressures of 20–25 mmHg during these maneuvers, by increasing the distance between the abdominal wall and intracavitary organs, can help reduce the risk of entry-related complications, without an increase in anesthetic adverse effects.

Methods and materials

Prospective observational analytic multi-centered cohort study with 703 patients. The exposed-cohort consisted of patients undergoing gynecological laparoscopic surgeries in which an intra-abdominal pressure of 20–25 mmHg was used (group 20–25 mmHg) as opposed to the unexposed-cohort, in which usual < 15 mmHg pressures (group < 15 mmHg) were used. All surgeries were performed using the Veress needle as the method of insufflation.

Results

Patients in whom access was performed at pressures < 15 mmHg had a higher risk of complications than those in whom elevated pressures of 20–25 mmHg were used, which was statistically significant (OR 3.08, 95% CI95% 1.42–6.65, p = 0.004), without finding differences regarding anesthetic complications (p = 0.9).

Conclusion

The use of high intraabdominal pressure during access maneuvers serves as an effective technique for the prevention of complications, especially major complications, when compared with standard-used pressures, without increasing the incidence of anesthetic adverse effects, due to their temporary maintenance.

Resumen

Introducción

Hasta la mitad de las complicaciones en cirugía laparoscópica ocurren durante las maniobras de acceso. Nuestro objetivo es determinar si presiones elevadas de 20-25 mmHg durante estas maniobras, al aumentar la distancia entre la pared abdominal y las estructuras intracavitarias, pueden reducir el riesgo de complicaciones de la entrada, sin incrementar los efectos adversos anestésicos.

Material y métodos

Estudio analítico observacional de cohortes prospectivo multicéntrico con 703 pacientes. La cohorte expuesta al factor de riesgo la conforman las pacientes sometidas a cirugías laparoscópicas ginecológicas con una presión intraabdominal de acceso de 20-25 mmHg. La cohorte no expuesta la conforman las pacientes en las que se ha utilizado presiones habituales < 15 mmHg.

Resultados

Las pacientes en las que se realizó el acceso a presiones < 15 mmHg presentaron un riesgo mayor de complicaciones que aquellas en las que se utilizaron presiones elevadas de 20-25 mmHg, siendo estadísticamente significativo (OR: 3,08; IC 95%: 1,42-6,65; p = 0,004), sin encontrar diferencias respecto a las complicaciones anestésicas (p = 0,9).

Conclusiones

El uso de presiones elevadas durante las maniobras de acceso a la cavidad abdominal puede constituir una técnica eficaz para prevenir las complicaciones, sobre todo las complicaciones mayores, respecto al acceso a presiones estándar; sin aumentar la incidencia de efectos adversos anestésicos, debido al mantenimiento transitorio de estas.