Users Manual

General Information
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WARNING!
Dehydration
Insufflation can lead to dehydration of the tissue, especially if the surgery time is
prolonged. This can lead to damage of peritoneal cell structures within the tissue.
Insufflation, especially with unconditioned gas, is associated with post-operative
pain. Long surgeries and large leaks increase the risk of dehydration especially at
the insertion points of the trocars.
The use of humidified and prewarmed gas can reduce risks associated with tissue
dehydration.
WARNING!
Embolism/insufflation of internal organs
Improper placement of the insufflation instrument could cause gas penetrating a
vessel or an internal organ, resulting in air or CO
2
embolisms. To reduce the risk,
use a low flow rate for the first insufflation and ensure that the insufflation instru-
ment is correctly positioned. Check the position of the insufflation instrument im-
mediately if the actual pressure rapidly reaches the nominal pressure value. CO
2
embolisms can also be caused by a high intra-abdominal pressure. Avoid high-pres-
sure settings and close damaged blood vessels at once.
WARNING!
Subcutaneous emphysema
Incorrect placement of a cannula or a trocar into subcutaneous tissue may lead to
emphysema. To reduce the risk, use a low gas flow rate for the initial insufflation
and ensure that the insufflation instrument is correctly positioned. Long surgeries,
the use of many access points, duration and size of leaks at these points may also
contribute to emphysema. Be sure to close leakages in trocar accesses immediately.
WARNING!
Subcutaneous emphysema
When puncturing the thicker abdominal wall of morbidly obese patients with the
Veress cannula or the trocar, carefully monitor the correct position of the instru-
ment in the abdomen.
WARNING!
Additional insufflation sources/automatic venting system
Make sure the automatic venting system is activated (see Chapter Menu (Over-
view) [} 51]). The use of additional insufflation sources increases the intra-ab-
dominal pressure. Continuously monitor intra-abdominal pressure over the course
of the entire insufflation if additional sources are used.
WARNING!
Altered Respiratory Physiology
Always monitor the patient's respiratory functions during the entire surgery. The
larger body mass supported by the thoracic cage and the larger amount of fat in
the abdominal cavity may reduce the elasticity of the thoracic wall. In addition, the
increased intra-abdominal pressure secondary to insufflation may alter the normal
physiological lung parameters thus resulting in a reduction of the functional lung
volume. Shallow, rapid breathing is symptomatic of this condition. Even modest
physical stress causes a tremendous increased demand for oxygen, which stands in
contrast to the ineffective respiratory musculature that requires more oxygen be-
cause it must overcome the reduced elasticity of the thoracic cage. The functional
capacity of the lungs is small and even moderate stress can lead to respiratory fail-
ure.
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DRAFT