Management of abdominal gas leakage from surgical trocars in laparoscopic surgery: a preclinical study

<b>Introduction:</b> There is an ongoing concern about the potential infectious risk due to pneumoperitoneal gas leakage from surgical trocars in laparoscopic surgery. We aimed to visually confirm the presence of leakage from trocars and investigate the changes in the leakage scale according to intra-abdominal pressures and trocar types. <b>Material and methods:</b> We established a porcine pneumoperitoneum model and performed experimental forceps manipulation using 5-mm grasping forceps with 12-mm trocars. The gas leakage, if any, was imaged using a Schlieren optical system, which can visualize minute gas flow invisible to the naked eye. For measuring the scale, we calculated the gas leakage velocity and area using image analysis software. Four types of unused and exhausted disposable trocars were compared. <b>Results:</b> Gas leakage was observed from trocars during forceps insertion and removal. Both the gas leakage velocity and area increased as the intra-abdominal pressure increased. Every type of trocar we handled was associated with gas leakage, and exhausted disposable trocars had the largest scale gas leakage. <b>Conclusions:</b> We confirmed gas leakage from trocars during device traffic. The scale of leakage increased with high intra-abdominal pressure and with the use of exhausted trocars. Current protection against gas leakage may not be sufficient and new surgical safety measures and device development may be needed in the future.

<b>引言：</b>目前，腹腔镜手术中手术套管针（trocar）引发的气腹气体泄漏存在潜在感染风险，这一问题持续受到关注。本研究旨在通过可视化手段确认套管针是否存在气体泄漏，并探究泄漏规模随腹腔内压力及套管针类型的变化规律。
<b>材料与方法：</b>本研究建立猪气腹模型，采用搭配12mm套管针的5mm持物钳开展钳夹操作实验。若存在气体泄漏，将使用纹影光学系统（Schlieren optical system）对其进行成像，该系统可可视化肉眼无法观测的微小气流。为量化泄漏规模，研究团队通过图像分析软件计算气体泄漏的流速与面积。本研究对比了4种全新及已使用的一次性套管针。
<b>结果：</b>研究观察到，在钳具插入及拔出套管针的过程中均存在气体泄漏现象。气体泄漏的流速与面积均随腹腔内压力升高而增大。本研究涉及的所有类型套管针均出现了气体泄漏，其中已使用的一次性套管针的泄漏规模最大。
<b>结论：</b>本研究证实，在器械经套管针通道进出时会发生气体泄漏。泄漏规模随腹腔内压力升高及使用过的套管针而增大。当前针对气体泄漏的防护措施或存在不足，未来需开发新型手术安全防护方案与相关器械。