TY - JOUR
T1 - Escape of surgical smoke particles, comparing conventional and valveless trocar systems
AU - Robertson, Daniel
AU - Sterke, Frank
AU - van Weteringen, Willem
AU - Arezzo, Alberto
AU - Mintz, Yoav
AU - the Technology committee of the European Association for Endoscopic Surgery (EAES)
AU - Boni, Luigi
AU - Baldari, Ludovica
AU - Chand, Manish
AU - Fuchs, Hans
AU - Ficuciello, Fanny
AU - Marconi, Stefania
AU - Mylonas, George
AU - Kim, Young Woo
AU - Nakajima, Kiyokazu
AU - Schijven, Marlies
AU - Valdastri, Pietro
AU - Sagiv, Chen
AU - Mascagni, Pietro
AU - Myśliwiec, Piotr
AU - Petz, Wanda
AU - Sánchez-Margallo, Francisco
AU - Horeman, Tim
N1 - Funding Information: The authors would like to thank all surgeons from the European Association for Endoscopic Surgery (EAES) committees for their role as scientific advisors and for sending trocars and instruments for evaluation. The Technology Committee of the European Association for Endoscopic Surgery (EAES) is composed of: Luigi Boni, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Italy, Ludovica Baldari MD, General Surgery, University of Milan, Italy, Thomas Carus, General, visceral and vascular surgery, Asklepios Westklinikum, Hamburg, Germany, Manish Chand, Welcome EPSRC Centre for Interventional and Surgical Sciences (WEISS) London. University College London Hospital, London, UK, Hans Fuchs, Department of Surgery, University of Cologne, Germany, Fanny Ficuciello, Università di Napoli Federico II, Napoli, Italy, Stefania Marconi, Dept. of Civil Engineering and Architecture, University of Pavia, Italy, George Mylonas, Human-centred Automation Robotics and Monitoring in Surgery (HARMS) Lab, Imperial College, London, UK, Young Woo Kim, National Cancer Center, Goyang, South Korea, Kiyokazu Nakajima, Department of Next Generation Endoscopic Intervention, Osaka, University Graduate School of Medicine, Osaka, Japan, Marlies Schijven, AMC—Academic Medical Centre, Amsterdam, The Netherlands, Pietro Valdastri, Institute of Robotics, Autonomous Systems and Sensing, School of Electronic and Electrical Engineering, University of Leeds, UK, Chen Sagiv, Co-CEO SagivTech Ltd, Raanana, Israel, Pietro Mascagni, Catholic University of the Sacred Heart, Rome, Italy&IHU-Strasbourg, University of Strasbourg, France, Piotr Myśliwiec, Department of General and Endocrine Surgery, Medical University of Bialystok Poland, Wanda Petz, Division of Digestive Surgery IEO (European Institute of Oncology) Milano, Italy, Francisco Sánchez-Margallo, JUMISC in Cáceres and Centre, University of Extremadura, Spain. Funding Information: This study was funded by the TU Delft Covid-19 Response Fund and the Covid-19 Fund of the European Association for Endoscopic Surgery (EAES). Publisher Copyright: © 2023, The Author(s).
PY - 2023/11
Y1 - 2023/11
N2 - Background: During minimal access surgery, surgical smoke is produced which can potentially be inhaled by the surgical team, leading to several health risks. This smoke can escape from the abdominal cavity into the operating room due to trocar leakage. The trocars and insufflator that are used during surgery influence gas leakage. Therefore, this study compares particle escape from a valveless (Conmed AirSeal iFS), and a conventional (Karl Storz Endoflator) system. Materials and methods: Using an in vitro model, a conventional and a valveless trocar system were compared. A protocol that simulated various surgical phases was defined to assess the surgical conditions and particle leakage. Insufflation pressures and instrument diameters were varied as these are known to affect gas leakage. Results: The conventional trocar leaked during two distinct phases. Removal of the obturator caused a sudden release of particles. During instrument insertion, an average of 211 (IQR 111) particles per second escaped when using the 5 mm diameter instrument. With the 10 mm instrument, 50 (IQR 13) particles per second were measured. With the conventional trocar, a higher abdominal pressure increased particle leakage. The valveless trocar demonstrated a continuously high particle release during all phases. After the obturator was removed, particle escape increased sharply. Particle escape decreased to 1276 (IQR 580) particles per second for the 5 mm instrument insertion, and 1084 (IQR 630) particles per second for 10 mm instrument insertion. With the valveless trocar system, a higher insufflation pressure lowered particle escape. Conclusions: This study shows that a valveless trocar system releases more particles into the operating room environment than a conventional trocar. During instrument insertion, the leakage through the valveless system is 6 to 20 times higher than the conventional system. With a valveless trocar, leakage decreases with increasing pressure. With both trocar types leakage depends on instrument diameter.
AB - Background: During minimal access surgery, surgical smoke is produced which can potentially be inhaled by the surgical team, leading to several health risks. This smoke can escape from the abdominal cavity into the operating room due to trocar leakage. The trocars and insufflator that are used during surgery influence gas leakage. Therefore, this study compares particle escape from a valveless (Conmed AirSeal iFS), and a conventional (Karl Storz Endoflator) system. Materials and methods: Using an in vitro model, a conventional and a valveless trocar system were compared. A protocol that simulated various surgical phases was defined to assess the surgical conditions and particle leakage. Insufflation pressures and instrument diameters were varied as these are known to affect gas leakage. Results: The conventional trocar leaked during two distinct phases. Removal of the obturator caused a sudden release of particles. During instrument insertion, an average of 211 (IQR 111) particles per second escaped when using the 5 mm diameter instrument. With the 10 mm instrument, 50 (IQR 13) particles per second were measured. With the conventional trocar, a higher abdominal pressure increased particle leakage. The valveless trocar demonstrated a continuously high particle release during all phases. After the obturator was removed, particle escape increased sharply. Particle escape decreased to 1276 (IQR 580) particles per second for the 5 mm instrument insertion, and 1084 (IQR 630) particles per second for 10 mm instrument insertion. With the valveless trocar system, a higher insufflation pressure lowered particle escape. Conclusions: This study shows that a valveless trocar system releases more particles into the operating room environment than a conventional trocar. During instrument insertion, the leakage through the valveless system is 6 to 20 times higher than the conventional system. With a valveless trocar, leakage decreases with increasing pressure. With both trocar types leakage depends on instrument diameter.
KW - Insufflation pressure
KW - Laparoscopy
KW - Surgical smoke
KW - Valveless insufflation
UR - http://www.scopus.com/inward/record.url?scp=85173917998&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00464-023-10444-9
DO - https://doi.org/10.1007/s00464-023-10444-9
M3 - Article
C2 - 37794124
SN - 0930-2794
VL - 37
SP - 8552
EP - 8561
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 11
ER -