Randomized trial comparing low-pressure versus standard-pressure pneumoperitoneum in laparoscopic colectomy: PAROS trial

S Celarier, S Monziols, M O Francois, V Assenat, P Carles, M Capdepont, C Fleming, E Rullier, G Napolitano, Q Denost, S Celarier, S Monziols, M O Francois, V Assenat, P Carles, M Capdepont, C Fleming, E Rullier, G Napolitano, Q Denost

Abstract

Background: Laparoscopy, by its minimally invasive nature, has revolutionized digestive and particularly colorectal surgery by decreasing post-operative pain, morbidity, and length of hospital stay. In this trial, we aim to assess whether low pressure in laparoscopic colonic surgery (7 mm Hg instead of 12 mm Hg) could further reduce pain, analgesic consumption, and morbidity, resulting in a shorter hospital stay.

Methods and analysis: The PAROS trial is a phase III, double-blind, randomized controlled trial. We aim to recruit 138 patients undergoing laparoscopic colectomy. Participants will be randomly assigned to either a low-pressure group (7 mm Hg) or a standard-pressure group (12 mm Hg). The primary outcome will be a comparison of length of hospital stay between the two groups. Secondary outcomes will compare post-operative pain, consumption of analgesics, morbidity within 30 days, technical and oncological quality of the surgical procedure, time to passage of flatus and stool, and ambulation. All adverse events will be recorded. Analysis will be performed on an intention-to-treat basis.

Trial registration: This research received the approval from the Committee for the Protection of Persons and was the subject of information to the ANSM. This search is saved in the ID-RCB database under registration number 2018-A03028-47. This research is retrospectively registered January 23, 2019, at http://clinicaltrials.gov/ed under the name "LaPAroscopic Low pRessure cOlorectal Surgery (PAROS)". This trial is ongoing.

Keywords: Colectomy; Laparoscopy; Low-pressure pneumoperitoneum.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Timeline of PAROS Study
Fig. 2
Fig. 2
PAROS Study analgesic protocol

References

    1. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359(9325):2224–2229. doi: 10.1016/S0140-6736(02)09290-5.
    1. Braga M, Frasson M, Zuliani W, Vignali A. Pecorelli. Randomized clinical trial of laparoscopic versus open left colonic resection. Br J Surg. 2010;97(8):1180–1186. doi: 10.1002/bjs.7094.
    1. Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS. Laparoscopic resectionof rectosigmoid carcinoma: prospective randomised trial. Lancet. 2004;363(9416):1187–1192. doi: 10.1016/S0140-6736(04)15947-3.
    1. Hasegawa H, Kabeshima Y, Watanabe M, Yamamoto S, Kitajima M. Controlled trial of laparoscopic versus open colectomy for advanced colorectal cancer. Surg Endosc. 2003;17(4):636–640. doi: 10.1007/s00464-002-8516-4.
    1. Bonjer HJ, Hop WC, Nelson H, Sargent DJ, Lacy AM, Castells A, et al. Transatlantic Laparoscopically Assisted vs Open Colectomy Trials Study Group. Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg. 2007;142(3):298–303. doi: 10.1001/archsurg.142.3.298.
    1. Klarenbeek BR, Bergamaschi R, Veenhof AA, van der Peet DL, van den Broek WT, de Lange ES, et al. Laparoscopic versus open sigmoid resection for diverticular disease: follow-up assessment of the randomized control Sigma trial. Surg Endosc. 2011;25(4):1121–1126. doi: 10.1007/s00464-010-1327-0.
    1. Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES, et al. Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the Sigma Trial. Ann Surg. 2009;249(1):39–44. doi: 10.1097/SLA.0b013e31818e416a.
    1. Panis Y, Maggiori L, Caranhac G, Bretagnol F, Vicaut E. Mortality after colorectal cancer surgery: a French survey of more than 84,000 patients. Ann Surg. 2011;254(5):738–743. doi: 10.1097/SLA.0b013e31823604ac.
    1. Perrin M, Fletcher A. Laparoscopic abdominal surgery. Contin Educ Anaesth Crit Care Pain. 2004;4(4):107–111. doi: 10.1093/bjaceaccp/mkh032.
    1. Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A, et al. The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc. 2002;16(7):1121–1143. doi: 10.1007/s00464-001-9166-7.
    1. Hua J, Gong J, Yao L, Zhou B, Song Z. Low-pressure versus standard-pressure pneumoperitoneum for laparoscopic cholecystectomy: a systematic review and meta-analysis. Am J Surg. 2014;208(1):143–150. doi: 10.1016/j.amjsurg.2013.09.027.
    1. de’ Angelis N, Abdalla S, Carra MC, Lizzi V, Martínez-Pérez A, Habibi A, et al. Low-impact laparoscopic cholecystectomy is associated with decreased postoperative morbidity in patients with sickle cell disease. Surg Endosc. 2018;32(5):2300–2311. doi: 10.1007/s00464-017-5925-y.
    1. Bucur P, Hofmann M, Menhadji A, Abedi G, Okhunov Z, Rinehart J, et al. Comparison of Pneumoperitoneum Stability between a valveless trocar system and conventional insufflation: A prospective Randomized Trial. Urology. 2016;94:274–280. doi: 10.1016/j.urology.2016.04.022.
    1. Covotta M, Claroni C, Torregiani G, Naccarato A, Tribuzi S, Zinilli A. A Prospective, Randomized, Clinical Trial on the effects of a Valveless Trocar on Respiratory Mechanics during Robotic Radical Cystectomy: A Pilot Study. Anesth Analg. 2017;124(6):1794–1801. doi: 10.1213/ANE.0000000000002027.
    1. Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Enhanced Recovery After Surgery Society. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr. 2012;31(6):783–800. doi: 10.1016/j.clnu.2012.08.013.

Source: PubMed

Подписаться