Characterisation of trocar associated gas leaks during laparoscopic surgery

Daniel Robertson; Frank Sterke; the Technology committee of the European Association for Endoscopic Surgery (EAES); Willem van Weteringen; Alberto Arezzo; Yoav Mintz; Felix Nickel; Luigi Boni; Ludovica Baldari; Thomas Carus; Manish Chand; Hans Fuchs; Fanny Ficuciello; Stefania Marconi; George Mylonas; Young Woo Kim; Kiyokazu Nakajima; Marlies Schijven; Pietro Valdastri; Chen Sagiv; Pietro Mascagni; Piotr Myśliwiec; Wanda Petz; Francisco Sánchez-Margallo; Tim Horeman

doi:10.1007/s00464-021-08807-1

Characterisation of trocar associated gas leaks during laparoscopic surgery

Daniel Robertson^*, Frank Sterke, the Technology committee of the European Association for Endoscopic Surgery (EAES), Willem van Weteringen, Alberto Arezzo, Yoav Mintz, Felix Nickel, Luigi Boni, Ludovica Baldari, Thomas Carus, Manish Chand, Hans Fuchs, Fanny Ficuciello, Stefania Marconi, George Mylonas, Young Woo Kim, Kiyokazu Nakajima, Marlies Schijven, Pietro Valdastri, Chen SagivPietro Mascagni, Piotr Myśliwiec, Wanda Petz, Francisco Sánchez-Margallo, Tim Horeman

^*Corresponding author for this work

Pediatric Surgery

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

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.

Original language	English
Pages (from-to)	4542-4551
Number of pages	10
Journal	Surgical Endoscopy
Volume	36
Issue number	6
Early online date	3 Nov 2021
DOIs	https://doi.org/10.1007/s00464-021-08807-1
Publication status	Published - Jun 2022

Bibliographical note

Funding 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.

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:
© 2021, The Author(s).

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Robertson, D., Sterke, F., the Technology committee of the European Association for Endoscopic Surgery (EAES), van Weteringen, W., Arezzo, A., Mintz, Y., Nickel, F., Boni, L., Baldari, L., Carus, T., Chand, M., Fuchs, H., Ficuciello, F., Marconi, S., Mylonas, G., Kim, Y. W., Nakajima, K., Schijven, M., Valdastri, P., ... Horeman, T. (2022). Characterisation of trocar associated gas leaks during laparoscopic surgery. Surgical Endoscopy, 36(6), 4542-4551. https://doi.org/10.1007/s00464-021-08807-1

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title = "Characterisation of trocar associated gas leaks during laparoscopic surgery",

abstract = "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.",

author = "Daniel Robertson and Frank Sterke and {the Technology committee of the European Association for Endoscopic Surgery (EAES)} and {van Weteringen}, Willem and Alberto Arezzo and Yoav Mintz and Felix Nickel and Luigi Boni and Ludovica Baldari and Thomas Carus and Manish Chand and Hans Fuchs and Fanny Ficuciello and Stefania Marconi and George Mylonas and Kim, {Young Woo} and Kiyokazu Nakajima and Marlies Schijven and Pietro Valdastri and Chen Sagiv and Pietro Mascagni and Piotr My{\'s}liwiec and Wanda Petz and Francisco S{\'a}nchez-Margallo and Tim Horeman",

note = "Funding 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{\textquoteright} 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, Universit{\`a} 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 My{\'s}liwiec, 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 S{\'a}nchez-Margallo, JUMISC in C{\'a}ceres 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: {\textcopyright} 2021, The Author(s).",

year = "2022",

month = jun,

doi = "10.1007/s00464-021-08807-1",

language = "English",

volume = "36",

pages = "4542--4551",

journal = "Surgical Endoscopy and Other Interventional Techniques",

issn = "0930-2794",

publisher = "Springer New York",

number = "6",

}

Robertson, D, Sterke, F, the Technology committee of the European Association for Endoscopic Surgery (EAES), van Weteringen, W, Arezzo, A, Mintz, Y, Nickel, F, Boni, L, Baldari, L, Carus, T, Chand, M, Fuchs, H, Ficuciello, F, Marconi, S, Mylonas, G, Kim, YW, Nakajima, K, Schijven, M, Valdastri, P, Sagiv, C, Mascagni, P, Myśliwiec, P, Petz, W, Sánchez-Margallo, F & Horeman, T 2022, 'Characterisation of trocar associated gas leaks during laparoscopic surgery', Surgical Endoscopy, vol. 36, no. 6, pp. 4542-4551. https://doi.org/10.1007/s00464-021-08807-1

TY - JOUR

T1 - Characterisation of trocar associated gas leaks during laparoscopic surgery

AU - Robertson, Daniel

AU - Sterke, Frank

AU - the Technology committee of the European Association for Endoscopic Surgery (EAES)

AU - van Weteringen, Willem

AU - Arezzo, Alberto

AU - Mintz, Yoav

AU - Nickel, Felix

AU - Boni, Luigi

AU - Baldari, Ludovica

AU - Carus, Thomas

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 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. 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: © 2021, The Author(s).

PY - 2022/6

Y1 - 2022/6

N2 - 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.

AB - 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.

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U2 - 10.1007/s00464-021-08807-1

DO - 10.1007/s00464-021-08807-1

M3 - Article

C2 - 34731302

AN - SCOPUS:85129246765

VL - 36

SP - 4542

EP - 4551

JO - Surgical Endoscopy and Other Interventional Techniques

JF - Surgical Endoscopy and Other Interventional Techniques

SN - 0930-2794

IS - 6

ER -

Characterisation of trocar associated gas leaks during laparoscopic surgery

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