Colon Carcinoma Clinical Trial
Official title:
Randomized Controlled Trial to Evaluate the Effect of a Retractor Sponge in Postoperative Hospital Stay in Laparoscopic Colorectal Surgery in Patients With Malignancy
Laparoscopic surgery of the distal colon and rectum requires surgery with an appropriate field of view. A commonly used technique to create a clear exposure is the steep Trendelenburg position in which the patient is positioned in an angle of 15 to 40 degrees with the head down using the effect of gravity to retract the small intestine. This method is associated with haemostatic changes caused by the cranial shift of abdominal organs and blood. Recently, a cellulose compressed sponge was developed as intraoperative retractor, with the aim to keep the small intestines aside while the patient remains in a horizontal position. The safety of the sponge is secured with CE marking. The retractor sponge ensures a clear surgical field and potentially prevents haemostatic instability by avoiding Trendelenburg position. A pilot study in the St Antonius Hospital Nieuwegein has shown that use of the sponge might be associated with shorter hospital stay.
Objective: We study the efficacy of the retractor sponge in laparoscopic colorectal surgery
to reduce hospital stay in patients operated for a malignancy. Secondary objectives are
duration of surgery, blood-loss, use of diuretics as volume therapy (during surgery as wells
as during total hospital stay), postoperative hypoxemia and peri- and postoperative
complications.
Study design: Randomized controlled trial, nested within a prospective cohort according to
the 'cohort multiple randomized controlled trial' (cmRCT) design.
Study population: Patients with colorectal cancer who undergo laparoscopic surgery, and who
have given informed consent to be offered experimental interventions within the PICNIC
project. Patient who require open surgery or patients with benign colorectal diseases are
excluded for this study.
Intervention: Intraoperative use of the retractor sponge versus usual care, i.e. the
Trendelenburg position.
Main study parameters/endpoints: The primary endpoint is length of hospital stay. Secondary
endpoints are duration of surgery, blood-loss, use of diuretics (during surgery as wells as
during total hospital stay), postoperative hypoxemia and peri- and postoperative surgical,
pulmonary and cardiac complications.
Nature and extent of the burden and risks associated with participation, benefit and group
relatedness: The study will be conducted according to the cohort multiple Randomized
Controlled Trial (cmRCT) design. Within the PICNIC cohort, we will identify all patients who
are eligible for the experimental intervention (use of the sponge) and who have given
informed consent to be invited for future experimental interventions. From this sub cohort,
we will randomly select a group of patients to whom we will offer surgery with use of the
retractor sponge, which they can accept or decline. Eligible patients from the sub cohort who
were not randomly selected will undergo standard treatment, i.e. surgery in Trendelenburg
position. We do not expect adverse events in patients in the intervention arm, besides
dysfunction of the sponge, after which conversion to standard treatment (Trendelenburg
position) needs to take place.
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