LAParoscopic Entry Technique in REnal Surgery

NCT ID: NCT03306238

Last Updated: 2017-12-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-11-01

Study Completion Date

2019-12-31

Brief Summary

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This is a randomised controlled trial to evaluate safety and efficacy of two different port site entry techniques in laparoscopic renal surgery: open method (Hasson) and closed method (Veress). It will involve 300 adult patients undergoing elective laparoscopic renal surgery in Tallaght hospital under two Consultant urologists.

Detailed Description

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Surgical specialties commonly using laparoscopic techniques like gynecology and general surgery have extensively compared the various available techniques of port insertion (1). There is very little known regarding the safest entry technique for the initial port in laparoscopic renal surgery. Results from other surgical specialties cannot simply be extrapolated to this type of laparoscopic surgery due to difference in entry site and patient position with renal surgery. Hence, this randomised controlled trial will be performed in a urological unit with two laparoscopic renal surgeons to compare two commonly used techniques of initial trocar insertion: the closed method and the open method.

Background Since its introduction in 1991 by Clayman, laparoscopic renal surgery has become very popular and is widely used for both benign and malignant renal operations such as radical, simple and partial nephrectomies, pyeloplasties, nephro-ureterectomies (2). The overall reported major and minor complication rate of laparoscopic renal surgery is 9.5% and 1.9% respectively (2). Initial entry by trocar insertion is the most hazardous part of the laparoscopic procedure. Opinion regarding the safest entry technique is divided. The two most commonly used techniques of port entry include open and closed (3). An open technique, as first described by Hasson, involves the peritoneum being cut down, followed by the insertion of a blunt trocar under direct visualisation, gas insufflation, and insertion of the laparoscope. One of the closed technique involves the insertion of a Veress needle (a needle equipped with a spring-loaded obturator) into the peritoneal cavity, followed by gas insufflation (act of blowing) and insertion of a trocar (a sharp, pointed instrument with a cannula used to enter the body cavity). Finally the laparoscope is passed through the trocar once the obturator is removed. Previous meta-analyses in laparoscopic surgery from gynaecological and general surgical operations have not been able to support one technique over the other due to insufficient evidence.to our knowledge (3), there are no randomised controlled trials comparing these two techniques in laparoscopic renal surgery. During laparoscopic renal surgery, the patient is placed in a lateral flank position with the table flexed. The initial port of entry can be either at the umbilicus or lateral to it. This position is unique to urological surgery and hence can have different implications to the initial trocar insertion technique.

The objective is to compare the open method (Hasson) and closed method (Veress) of laparoscopic port site entry in renal surgery

Conditions

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Kidney Diseases

Keywords

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laparoscopy/ key-hole renal surgery open/hasson closed/veress

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This is a randomised single blinded prospective trial comparing two similar groups directly to check for differnces in time to approach and complication rate
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors
The patient and the investigator will not be informed of the type of approach they had. These will be marked as A and B with only the care povide/surgeon being aware of the actual approach. The investigator of complications and assessor of the case outcomes will collect data without the knowledge of the group the patient belongs to. The surgeon or car eprovider cannot be masked in this case due to technical limitations but they will not contribute towards analysing the results.

Study Groups

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Open/Hasson

This group will undergo initial laparoscopic port insertion by the open or Hasson approach and then undergo the remaining laparoscopic surgery as usual

Group Type ACTIVE_COMPARATOR

Open approach to port insertion

Intervention Type PROCEDURE

This involves the peritoneum being cut down, followed by the insertion of a blunt trocar under direct visualisation, gas insufflation, and insertion of the laparoscope

Closed/ Veress

This group will undergo initial laparoscopic port insertion by the closed or Veress approach and then undergo the remaining laparoscopic surgery as usual

Group Type ACTIVE_COMPARATOR

Closed approach to port insertion

Intervention Type PROCEDURE

This involves the insertion of a Veress needle (a needle equipped with a spring-loaded obturator) into the peritoneal cavity, followed by gas insufflation (act of blowing) and insertion of a trocar (a sharp, pointed instrument with a cannula used to enter the body cavity).

Interventions

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Open approach to port insertion

This involves the peritoneum being cut down, followed by the insertion of a blunt trocar under direct visualisation, gas insufflation, and insertion of the laparoscope

Intervention Type PROCEDURE

Closed approach to port insertion

This involves the insertion of a Veress needle (a needle equipped with a spring-loaded obturator) into the peritoneal cavity, followed by gas insufflation (act of blowing) and insertion of a trocar (a sharp, pointed instrument with a cannula used to enter the body cavity).

Intervention Type PROCEDURE

Other Intervention Names

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Hasson Veress

Eligibility Criteria

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Inclusion Criteria

* • Able to undergo a general anaesthetic

* At least 18 years old
* Willing and able to give AN INFORMED CONSENT

Exclusion Criteria

* patient refusal obese patients BMI \>40mg/m2 previous laparotomy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Adelaide and Meath Hospital, incorporating The National Children's Hospital

OTHER

Sponsor Role lead

Responsible Party

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Arun Thomas

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Arun Z Thomas

Role: PRINCIPAL_INVESTIGATOR

AMNCH, Tallaght hospital, Dublin 24

Locations

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Adelaide and Meath hospital incorporating the NAtional Children's hospital

Dublin, , Ireland

Site Status RECRUITING

Countries

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Ireland

Central Contacts

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Arun Z Thomas, MCh, FRCS

Role: CONTACT

Phone: 0353879804873

Email: [email protected]

Facility Contacts

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Arun Z Thomas, MCh, FRCS

Role: primary

References

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Angioli R, Terranova C, De Cicco Nardone C, Cafa EV, Damiani P, Portuesi R, Muzii L, Plotti F, Zullo MA, Panici PB. A comparison of three different entry techniques in gynecological laparoscopic surgery: a randomized prospective trial. Eur J Obstet Gynecol Reprod Biol. 2013 Dec;171(2):339-42. doi: 10.1016/j.ejogrb.2013.09.012. Epub 2013 Sep 23.

Reference Type BACKGROUND
PMID: 24103531 (View on PubMed)

Pareek G, Hedican SP, Gee JR, Bruskewitz RC, Nakada SY. Meta-analysis of the complications of laparoscopic renal surgery: comparison of procedures and techniques. J Urol. 2006 Apr;175(4):1208-13. doi: 10.1016/S0022-5347(05)00639-7.

Reference Type BACKGROUND
PMID: 16515961 (View on PubMed)

Ahmad G, O'Flynn H, Duffy JM, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2012 Feb 15;(2):CD006583. doi: 10.1002/14651858.CD006583.pub3.

Reference Type BACKGROUND
PMID: 22336819 (View on PubMed)

Other Identifiers

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AMNCH-GU-2017-3

Identifier Type: -

Identifier Source: org_study_id