3 0
S U P P L E M E N T T O O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | M O N T H 2 0 1 4
tain insufflation equilibrium by detecting drops or peaks in pressure and auto-
matically adjusting CO
2
flow to maintain a preset pressure can help.
One of the best ways to prevent intra-abdominal pressure loss is with an
insufflation system that can blow fast enough to replace leaked CO
2
. For
instance, newer insufflation machines blow 30 to 50L per minute through high-
flow tubing versus older models that blew at 10L a minute, which wasn't enough
to adequately replenish lost CO
2
.
A focus on safety
Appendix and gallbladder removals are straightforward, high-volume proce-
dures that most surgeons can accomplish with any working piece of equip-
ment. But advanced laparoscopic procedures — complicated and prolonged
cases that aren't done on a daily basis, such as lap adrenalectomy or lap
paraesophageal hernia repair — require additional ammunition. It's not that
gallbladders are safer than advanced cases, it's that complex procedures
require more tools to accomplish safely, and every bit of visual-aid technol-
ogy helps.
It might be hard to prove that operating without the crispest images or visibili-
ty-enhancing tools can slow surgeons down, but there's little argument that poor
visualization is unsafe. When it comes to improving the views of laparoscopy,
patient safety should be the primary concern.
OSM
Dr. Oleynikov (
doleynik@unmc.edu
) is a professor of surgery and director of mini-
mally invasive and robotic surgery and the Center for Advanced Surgical Technology at
the Nebraska Medical Center in Omaha.
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