Laparoscopic Pneumoperitoneum: Impact of Body Habitus

Abstract

The purpose of this study was to determine the relationships among pneumoperitoneum pressure, CO2 insufflation volume, and patient height, weight, and body mass index. Forty-one male patients undergoing laparoscopic urologic procedures prospectively had a record made of the delivered volume of CO2 during insufflation to attain intraabdominal pressures of 5, 10, 15, 20, 25, and 30 mm Hg. The relationship of the delivered volume of CO2 insufflated and the intraabdominal pressure was compared statistically to the patient height, weight, and body mass index. In addition, six domestic female pigs underwent pneumoperitoneum, and the abdominal volume was calculated for intraabdominal pressures of 0, 5, 10, 15, 20, 25, and 30 mm Hg. Four different commercially available 10-mm trocars were tested for force required for placement at intraabdominal pressures of 15 and 30 mm Hg. There was a direct relationship between delivered volume of CO2 insufflated and the pneumoperitoneum pressure. There was no significant relationship between the delivered volume of CO2 insufflated at a given intraabdominal pressure and the patient height, weight, or body mass index. During insufflation, 94% of the abdominal volume is achieved by insufflating to 15 mm Hg. There is no significant difference in the force required for insertion of different ports at 15 mm vs 30 mm Hg pressure. Increasing the abdominal pressure to 30 mm Hg provides a 50% increase in the volume of CO2 insufflated vs a standard 15 mm Hg pneumoperitoneum. However, this additional volume does not significantly change the actual abdominal volume or diminish the pressure necessary to insert a trocar.

The role of abdominal compliance, the neglected parameter in critically ill patients — a consensus review of 16. Part 2: measurement techniques and management recommendations

“…It has been observed that the compliance of the abdominal cavity decreases when additional volume is added to the abdominal cavity [37]. This was confirmed clinically by McDougall et al and Abu-Rafea et al who examined 41 and 100 patients respectively during laparoscopy with CO 2 pneumoperitoneum [38,39]. The linear abdominal volume-pressure curve changed to a rather exponential shape when a pressure of 15 mm Hg was achieved by insufflating 3 and 4.5 L of CO 2 in each study (Fig.…”

“…The linear abdominal volume-pressure curve changed to a rather exponential shape when a pressure of 15 mm Hg was achieved by insufflating 3 and 4.5 L of CO 2 in each study (Fig. 9, derived from [38,39]). In their studies, the initial abdominal compliance at the beginning of the CO 2 inflation varied between 333 and 400 mL (mm Hg) -1 and at higher IAV (with corresponding IAP above 15 mm Hg) the C ab dropped to 60 and 90 mL (mm Hg) -1 respectively [38,39].…”

“…9, derived from [38,39]). In their studies, the initial abdominal compliance at the beginning of the CO 2 inflation varied between 333 and 400 mL (mm Hg) -1 and at higher IAV (with corresponding IAP above 15 mm Hg) the C ab dropped to 60 and 90 mL (mm Hg) -1 respectively [38,39]. Other studies have also examined C ab by assessment of IAP values with at least two corresponding IAV measurements before and after CO 2 -insufflation [40−43].…”

The Neglected Role of Abdominal Compliance in Organ-Organ Interactions

“…During laparoscopy with limitation of insufflation pressures at 12 to 15 mmHg, the IAV did not reach a critical point at which an exponential increase in IAP occured [13]. As discussed above, the initial phase of the PV curve may indeed be linear (as observed during laparoscopy) but the remaining part is curvilinear or rather exponential [13][14][15]. Because of this exponential relationship, it is important to know both the shape and the position on the curve, as the actual position will determine the corresponding C ab .…”

Effects of Deep Versus Moderate Neuromuscular Blockade in Laparoscopic Gynecologic Surgery on Postoperative Pain and Surgical Conditions: Protocol for a Randomized Controlled Trial (Preprint)

“…However, it is performed in a restricted space that may limit the surgeon's view and range of motion. Higher CO 2 insufflation pressure provides more insufflation volume [28], and improves surgical field visibility [29], but is associated with increased postoperative side effects [1]. During laparoscopic procedures, maintaining deep NMB, compared to moderate NMB, is associated with improved surgical conditions, as reviewed in [17].…”