Creation of pneumoperitoneum: noninvasive monitoring of clinical effects of elevated intraperitoneal pressure for the insertion of the first trocar

Abstract

Transitory, high intraperitoneal pressure (20 mmHg for 5 min) for insertion of the first trocar resulted in changes in HR, MAP, ETCO(2), and ITP that were within the normal range, and no adverse clinical effects were observed. Therefore, the use of transitory, high intraperitoneal pressure is recommended to prevent iatrogenic injury during blind insertion of the first trocar. Nevertheless, it is not clear that this method would be safe in patients with moderate to severe chronic obstructive pulmonary disease.

Comparison of Two Entry Methods for Laparoscopic Port Entry: Technical Point of VIEW

“…Studies have demonstrated that patients submitted to high intraperitoneal pressure for longer periods of time can present decreased cardiac output, decreased venous return, increased mean arterial pressure, increased systemic vascular resistance, altered renal perfusion and glomerular filtration rate, and ischemia-reperfusion injury of intraabdominal organs [39]. Therefore, most authors have proposed that intraperitoneal pressure remains at 12 mmHg and never above 15 mmHg during laparoscopic procedures.…”

Hemodynamic effects of laparoscopic radiofrequency ablation of liver tumors versus laparoscopic hepatic ultrasound examination

“…Similarly, laparoscopy did not cause any hemodynamic compromise in our patient groups as shown by the unchanged hemodynamic measurements before and after abdominal insufflation. One factor that may significantly affect hemodynamics in laparoscopic surgery is an elevated intraperitoneal pressure produced by gas insufflation for the creation of pneumoperitoneum [13]. However, as per our routine protocol, we limited intraperitoneal pressure to no more than 15 mmHg.…”

Laparoscopic management of a large torted ovarian cyst in an adolescent virgin: a case report

“…Intra-abdominal pressure is referred to in the literature as a safe measure to overcome entry-related complications,7 and some reports indicate that an increase in intra-abdominal pressure of over 20 mmHg for a period of 5 minutes is associated with changes in heart rate, mean arterial blood pressure, arterial oxygen saturation, and intratracheal pressure that are still within the normal range 8. Other reports advocate the use of higher intra-abdominal pressure for additional safety to protect against organ injury because there are no changes in cardiovascular parameters between 15 mmHg and 30 mmHg 9.…”