Background: During laparoscopy, the abdominal cavity is insufflated with carbon dioxide (CO2) that could become contaminated with viruses and surgical smoke. Medical staff is potentially exposed when this gas leaks into the operating room through the instruments and past trocar valves. No detailed studies currently exist that have quantified these leakage pathways. Therefore, the goal of this study was to quantify the gas leakages through trocars and instruments, during minimally invasive procedures. Methods: A model of the surgical environment was created, consisting of a rigid container with an interface for airtight clamping of laparoscopic equipment such as trocars and surgical instruments. The model was insufflated to 15 mm Hg using a pressure generator and a pneumotachograph measured the equipment gas leak. A protocol of several use cases was designed to simulate the motions and forces the surgeon exerts on the trocar during surgery. Results: Twenty-three individual trocars and twenty-six laparoscopic instruments were measured for leakage under the different conditions of the protocol. Trocar leakages varied between 0 L/min and more than 30 L/min, the instruments revealed a range of leakages between 0 L/min and 5.5 L/min. The results showed that leakage performance varied widely between trocars and instruments and that the performance and location of the valves influenced trocar leakage. Conclusions: We propose trocar redesigns to overcome specific causes of gas leaks. Moreover, an international testing standard for CO2 leakage for all new trocars and instruments is needed so surgical teams can avoid this potential health hazard when selecting new equipment.
Bibliographical noteFunding Information:
The authors like to thank all surgeons from the different European Association for Endoscopic Surgery (EAES) committees for their role as scientific advisors and 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. Dr. 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, Department 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.
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).
© 2021, The Author(s).