- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04250883
Low Pressure Pneumoperitoneum and Deep Neuromuscular Block Versus Standard Laparoscopy During Robot Assisted Radical Prostatectomy to Improve the Quality of Recovery and Immune Homeostasis; Study Protocol for a Randomized Controlled Study. (RECOVER-2)
Low Pressure Pneumoperitoneum and Deep Neuromuscular Blockade Versus Standard Laparoscopy During RARP to Improve the Quality of Recovery and Immune Homeostasis; Study Protocol for a Randomized Controlled Study
Intra-abdominal pressure (IAP) needed to create sufficient workspace during laparoscopic surgery affects the surrounding organs with ischemia-reperfusion injury and a systemic immune response. This effect is related to postoperative recovery, pain scores, opioid consumption, bowel function recovery, morbidity and possibly mortality. In clinical practice standard pressures of 12-16mmHg are applied instead of the lowest possible IAP, but accumulating evidence shows lower pressure pneumoperitoneum (PNP) (6-8mmHg) to be non-compromising for sufficient workspace, when combined with deep neuromuscular blockade (NMB) in a vast majority of patients. Therefore, low impact laparoscopy, meaning low pressure PNP facilitated by deep NMB, could be a valuable addition to Enhanced Recovery After Surgery (ERAS) Protocols.
The use of low pressure PNP may also reduce hypoxic injury and the release of DAMPs and thereby contributing to a better preservation of innate immune function which may help to reduce the risk of infectious complications.
The participants will be randomly assigned to one of the experimental groups with low impact laparoscopy or one of the control groups with standard laparoscopy.
Study Overview
Status
Detailed Description
Intra-abdominal pressure (IAP) needed to create sufficient workspace during laparoscopic surgery affects the surrounding organs with ischemia-reperfusion injury and a systemic immune response. This effect is related to postoperative recovery, pain scores, opioid consumption, bowel function recovery, morbidity and possibly mortality. Therefore, low impact laparoscopy, meaning low pressure PNP facilitated by deep NMB, could be a valuable addition to Enhanced Recovery After Surgery (ERAS) Protocols.
The use of low pressure PNP may also reduce hypoxic injury and the release of DAMPs and thereby contributing to a better preservation of innate immune function which may help to reduce the risk of infectious complications.
The participants will be randomly assigned to the experimental group 1: low impact laparoscopy (low pressure (8 mmHg) and deep NMB (PTC 1-2)); 8 mmHg IAP after trocar introduction for perfusion measurement or the experimental group 2: low impact laparoscopy (low pressure (8 mmHg) and deep NMB (PTC 1-2)); 12 mmHg IAP after trocar introduction for perfusion measurement, or control group 1: standard laparoscopy (standard pressure (12 mmHg) and moderate NMB (TOF 1-2)); 8 mmHg IAP after trocar introduction for perfusion measurement, or control group 2: standard laparoscopy (standard pressure (12 mmHg) and moderate NMB (TOF 1-2)); 12 mmHg IAP after trocar introduction for perfusion measurement.
ICG injection will take place with starting pressure to quantify parietal peritoneum perfusion, and a parietal peritoneal biopsy will be taken. At the end of surgery, a second parietal peritoneum biopsy will be taken.
NB: After introduction of the camera trocar, insufflation of carbon dioxide is titrated to an IAP of 8mmHg in group A and C, and 14 mmHg in group B and D. After placement of the last trocar the injection of ICG and video registration of peritoneum will take place, and a peritoneal biopsy will be taken. There after surgery will take place with an IAP of 14mmHg in the control groups (C and D), and an IAP of 8mmHg in the experimental groups (A and B). In the control groups (C and D)
Pre- and postoperative a few questionnaires will be taken and blood withdrawals to evaluate the quality of recovery, and the immune response.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Nijmegen, Netherlands
- Canisius Wilhelmina Ziekenhuis
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- - Age ≥ 18 years
- Undergoing elective robot assisted radical prostatectomy (RARP)
- Obtained informed consent
Exclusion Criteria:
- Laparoscopic radical prostatectomy without robot assistance
- Insufficient control of the Dutch language to read the patient information and to fill out de questionnaires
- Neo-adjuvant chemotherapy
- Chronic use of analgesics or psychotropic drugs
- Use of NSAID's shorter than 5 days before surgery
- Severe liver- or renal disease
- Neuromuscular disease
- Hyperthyroidism or thyroid adenomas
- Deficiency of vitamin K dependent clotting factors or coagulopathy
- Planned diagnostics or treatment with radioactive iodine < 1 week after surgery
- Indication for rapid sequence induction
- BMI >35kg/m2
- Known of suspected hypersensitivity to ICG, sodium iodide, iodine, rocuronium or sugammadex
- Use of medication interfering with ICG absorption as listed in the summary of product characteristics (SPC); anticonvulsants, bisulphite compounds, haloperidol, heroin, meperidine, metamizol, methadone, morphium, nitrofurantoin, opium alkaloids, phenobarbital, phenylbutazone, cyclopropane, probencid
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Single Group Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Experimental group: Low Impact laparoscopy
low impact laparoscopy (low pressure (8 mmHg) and deep NMB (PTC 1-2)
|
8 mmHg
Deep NMB (PTC1-2)
|
Active Comparator: Control group: Standard laparoscopy
standard laparoscopy (standard pressure (14 mmHg) and moderate NMB (TOF 1-2)
|
14 mmHg
Moderate NMB (TOF 1-2)
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Quality of recovery - 40 items questionnaire score (QoR-40)
Time Frame: at postoperative day 1
|
40 points (minimum: extremely poor quality of recovery) to 200 points (maximum: excellent quality of recovery)
|
at postoperative day 1
|
Immune response represented by IL-6
Time Frame: at postoperative day 1
|
IL-6 response upon whole blood LPS stimulation
|
at postoperative day 1
|
Immune response represented by IL-10
Time Frame: at postoperative day 1
|
IL-10 response upon whole blood LPS stimulation
|
at postoperative day 1
|
Perfusion index of the parietal peritoneum
Time Frame: From ICG injection, up to 20 seconds
|
calculated from the slope of ICG fluorescence intensity, and time to maximal intensity in seconds.
(extracted from video registration).
|
From ICG injection, up to 20 seconds
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Quality of recovery - 40 items questionnaire score (QoR-40)
Time Frame: day 10 after surgery
|
40 points (minimum: extremely poor quality of recovery) to 200 points (maximum: excellent quality of recovery)
|
day 10 after surgery
|
Health status with short form survey (SF-36)
Time Frame: day 10 and 3 months after surgery
|
The lower the score the more disability.
The higher the score the less disability.
|
day 10 and 3 months after surgery
|
Chronic pain with McGill pain questionnaire (MPQ)
Time Frame: 3 months after surgery
|
range from 0 (no pain) to 78 (severe pain)
|
3 months after surgery
|
Pain score with VAS
Time Frame: During hospital stay up to 3 days
|
pain scores with VAS 0 (no pain) to 10 (severe pain)
|
During hospital stay up to 3 days
|
Analgesia use
Time Frame: During hospital stay up to 3 days
|
non-cumulative and cumulative opioid use per day in morphine equivalent
|
During hospital stay up to 3 days
|
PONV
Time Frame: During hospital stay up to 3 days
|
With PONV impact scale score o (no PONV) to 6 (extreme PONV)
|
During hospital stay up to 3 days
|
Hospital stay
Time Frame: from admission up to 3 days
|
length of hospital stay in days
|
from admission up to 3 days
|
Postoperative recovery time
Time Frame: From day of surgery up to 3 days
|
time to reach discharge criteria in days
|
From day of surgery up to 3 days
|
Operating conditions
Time Frame: During operation for up to 8 hours
|
surgical conditions with L-SRS 0 (extremely poor work field) to 5 (excellent work field)
|
During operation for up to 8 hours
|
Complications
Time Frame: Day of surgery untill 30days after surgery
|
postoperative complications scored by Clavien Dindo classification; grade 0 (no deviation from ideal) grade 5 (death of patient)
|
Day of surgery untill 30days after surgery
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Michiel Warlé, Dr., Radboud University Medical Center
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- NL72780.091.20
- 2020-000411-79 (EudraCT Number)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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