Prestretching increases working space at the same insufflation pressure in dogs undergoing laparoscopic procedures.

Abstract

Objective: To determine if prestretching (PS) of the abdominal wall provided improved working space during elective laparoscopic procedures in dogs.

Study design: Prospective cohort study.

Animals: Fifty client-owned dogs undergoing elective laparoscopic procedures.

Methods: Skin markings were used to evaluate stretching of the abdominal wall. The distance from the subumbilical port to the caudal aspect of the gallbladder was measured as a proxy for intra-abdominal working length (IWL). Prestretching was performed by insufflating to an intra-abdominal pressure (IAP) of 10 mmHg for 3 min. The abdomen was desufflated back to 6 mmHg for the remainder of the procedure. A computed volumetric value utilizing skin measurements and IWL was used as a proxy for intra-abdominal working space (IWS). Percentage changes in IWL and IWS were compared.

Results: Increasing the IAP from 6 to 10 mmHg increased the IWL by 7% (IQR 9.5%) and the IWS by 10.4% (IQR 13.8%) (p = .004 and .005, respectively). Returning to 6 mmHg after prestretching resulted in a median increase in IWL of 4.4% (IQR 5.7%) and IWS of 6.9% (IQR 5.4%) compared with the initial 6 mmHg IAP measurements (p < .001 for both). Intra-abdominal working length and IWS were similar at the end of surgery compared with post-PS 6 mmHg IAP measurements.

Conclusion: Prestretching resulted in improved IWL and IWS, although not to the extent achieved by higher insufflation pressures. The effects of PS persisted throughout the laparoscopic procedures performed in this study.

Clinical significance: Prestretching can provide additional laparoscopic IWL and IWS at a lower IAP.