{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T22:34:28Z","timestamp":1777588468299,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T00:00:00Z","timestamp":1654041600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Endourology"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      A correlation between atypical recurrences and minimally-invasive surgery has been suggested in case of urothelial cancer; however, few data are available on the role of pneumoperitoneum in terms of gas flow and intra-abdominal pressure. The objective of the study is to analyze the impact of CO\n                      <jats:sub>2<\/jats:sub>\n                      pneumoperitoneum variation on an inert material as surrogate of neoplastic cells.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods:<\/jats:title>\n                    <jats:p>\n                      We designed an experimental model mimicking pneumoperitoneum in three settings: sealed flow (no leakage), pulsatile flow (alternating efflux and influx), and continuous flow (AirSeal\n                      <jats:sup>\u00ae<\/jats:sup>\n                      insufflator). Each experiment was characterized by a predetermined gas flow and pressure, trocar distance, and position from the particles. Hounsfield density (HD) variation in the areas of interest was measured as index of graphite powder dispersion. A Linear Regression Model was used to measure the correlation between modifiable variables and HD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      HD was lower in the pulsatile compared to both the sealed and continuous flows (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.03). On multivariate analysis for sealed setting, flow and total gas liters delivered (i.e., gas leakage) were inversely and independently related to HD (all\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.03). In pulsatile setting, trocar position, trocar distance, and gas flow independently predicted HD (all\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.03). In continuous setting, gas pressure was directly and independently related to HD (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.004) due to decreased pneumoperitoneum stability and increased CO\n                      <jats:sub>2<\/jats:sub>\n                      liters delivered. In case of inflow trocar positioned laterally to the particles, low flow (1\u2009L\/min), or low pressure (8\u2009mmHg), HD values recorded in the three settings were all overlapping (all\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&gt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      Flow and pressure setting, inflow trocar distance and contiguity from the tumor, and pneumoperitoneum stability may be all crucial components in minimally invasive surgery.\n                      <jats:italic toggle=\"yes\">In vivo<\/jats:italic>\n                      , these variables should be considered as potential risk factors for tumor cells spread within the abdominal cavity.\n                    <\/jats:p>\n                    <jats:p>Clinical Trial Registration number: NCT01740011.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/end.2021.0336","type":"journal-article","created":{"date-parts":[[2021,11,13]],"date-time":"2021-11-13T10:20:07Z","timestamp":1636798807000},"page":"807-813","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["The Effect of CO\n                    <sub>2<\/sub>\n                    Pressure and Flow Variation on Carbon Particles Spread During Pneumoperitoneum: An Experimental Study"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3316-5691","authenticated-orcid":false,"given":"Andrea","family":"Gallioli","sequence":"first","affiliation":[{"name":"Urology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy."},{"name":"Department of Urology, Fundaci\u00f3 Puigvert, Autonomous University of Barcelona, Barcelona, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"De Lorenzis","sequence":"additional","affiliation":[{"name":"Urology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy."},{"name":"Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Lievore","sequence":"additional","affiliation":[{"name":"Urology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Boeri","sequence":"additional","affiliation":[{"name":"Urology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy."},{"name":"Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Colombo","sequence":"additional","affiliation":[{"name":"Urology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Fontana","sequence":"additional","affiliation":[{"name":"Urology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Breda","sequence":"additional","affiliation":[{"name":"Department of Urology, Fundaci\u00f3 Puigvert, Autonomous University of Barcelona, Barcelona, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuele","family":"Montanari","sequence":"additional","affiliation":[{"name":"Urology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy."},{"name":"Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giancarlo","family":"Albo","sequence":"additional","affiliation":[{"name":"Urology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy."},{"name":"Department of Clinical Sciences and Community Health, University of Milan, Milan, 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