Vol.:(0123456789) 1 3 Surgical Endoscopy https://doi.org/10.1007/s00464-018-6039-x Impact of valve-less vs. standard insufation on pneumoperitoneum volume, infammation, and peritoneal physiology in a laparoscopic sigmoid resection experimental model Michele Diana 1,2,3,4  · Eric Noll 5  · Andras Legnèr 2  · Seong‑Ho Kong 2,6  · Yu‑Yin Liu 1  · Luigi Schiraldi 1  · Francesco Marchegiani 2  · Jordan Bano 1  · Bernard Geny 3  · Anne‑Laure Charles 3  · Bernard Dallemagne 1  · Véronique Lindner 7  · Didier Mutter 4  · Pierre Diemunsch 5  · Jacques Marescaux 1,2 Received: 24 July 2017 / Accepted: 3 January 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Background Standard insufators compensate for intra-abdominal pressure variations with pressure spikes. Our aim was to evaluate the impact of a stable, low-pressure pneumoperitoneum induced by a valve-less insufator, on working space, hemodynamics, infammation, and peritoneal physiology, in a model of laparoscopic sigmoid resection. Materials and methods Twelve pigs (47 ± 3.3 kg) were equipped for invasive hemodynamic monitoring and randomly assigned to Standard (n = 6) vs. valve-less (n = 6) insufation. Animals were positioned in a 30° Trendelenburg on a CT scan bed. A low-pressure pneumoperitoneum (8 mmHg) was started and duration was set for 180 min. Abdominal CT scans were performed, under neuromuscular blockade, before, immediately after, and 1 and 3 h after insufation. Pneumoperitoneum volumes were calculated on 3D reconstructed CT scans. After creation of a mesenteric window, capillary blood was obtained by puncturing the sigmoid serosa and local lactatemia (mmol/L) was measured using a handheld analyzer. Surgical resection was performed according to the level of lactates, in order to standardize bowel stump perfusion. IL-1 and IL-6 (ng/mL) were measured repeatedly. The peritoneum was sampled close to the surgical site and distantly for the oxygraphic assessment of mitochondrial respiration. A pathologist applied a semi-quantitative score to evaluate the anastomosis. Results Mean arterial pressure, pulse, body temperature, oximetry, systemic lactatemia, and local lactates were similar. IL-6 was lower in the valve-less group, reaching a statistically signifcant diference after 3 h of insufation (64.85 ± 32.5 vs. 133.95 ± 59.73; p = 0.038) and 48 h (77.53 ± 68.4 vs. 190.74 ± 140.79; p = 0.029). Peritoneal mitochondrial respiration was signifcantly increased after the survival period, with no diference among the groups. The anastomoses in the valve-less group demonstrated a lower acute (p = 0.04) infammatory infltration. The mean anterior posterior thickness was slightly, yet signifcantly higher in the valve-less group, on all post-insufation CT scans. Conclusions Valve-less insufation achieved a slightly higher working space and a lower systemic and localized infamma- tory response in this experimental setting. Keywords Valve-less insufator · Stable pneumoperitoneum · Peritoneal mitochondrial respiration rate · Capillary lactates · Metabolism-guided bowel resection and Other Interventional Techniques This study was presented at the 24th International Congress of the EAES, June 15–18, 2016, in Amsterdam, Netherlands. * Michele Diana michele.diana@ircad.fr 1 IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France 2 Institute for Image-Guided Surgery, IHU-Strasbourg, 1, place de l’Hôpital, 67091 Strasbourg, France 3 Physiology Institute, EA3072 Mitochondria and Oxidative Stress, University of Strasbourg, Strasbourg, France 4 Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France 5 Anesthesiology Department, University Hospital of Strasbourg, Strasbourg, France 6 Department of Surgery, Seoul National University Hospital, Seoul, South Korea 7 Pathology Department, University Hospital of Strasbourg, Strasbourg, France