Pneumoperitoneum in Veterinary Laparoscopy: A Review

Abstract

Objective: To review the effects of carbon dioxide pneumoperitoneum during laparoscopy, evaluate alternative techniques to establishing a working space and compare this to current recommendations in veterinary surgery. Study Design: Literature review. Sample Population: 92 peer-reviewed articles. Methods: An electronic database search identified human and veterinary literature on the effects of pneumoperitoneum (carbon dioxide insufflation for laparoscopy) and alternatives with a focus on adaptation to the veterinary field. Results: Laparoscopy is the preferred surgical approach for many human and several veterinary procedures due to the lower morbidity associated with minimally invasive surgery, compared to laparotomy. The establishment of a pneumoperitoneum with a gas most commonly facilitates a working space. Carbon dioxide is the preferred gas for insufflation as it is inert, inexpensive, noncombustible, colorless, excreted by the lungs and highly soluble in water. Detrimental side effects such as acidosis, hypercapnia, reduction in cardiac output, decreased pulmonary compliance, hypothermia and post-operative pain have been associated with a pneumoperitoneum established with CO2 insufflation. As such alternatives have been suggested such as helium, nitrous oxide, warmed and humidified carbon dioxide and gasless laparoscopy. None of these alternatives have found a consistent benefit over standard carbon dioxide insufflation. Conclusions: The physiologic alterations seen with CO2 insufflation at the current recommended intra-abdominal pressures are mild and of transient duration. Clinical Significance: The current recommendations in veterinary laparoscopy for a pneumoperitoneum using carbon dioxide appear to be safe and effective.

Laparoscopic versus Open Ovariectomy in Bitches: Changes in Cardiorespiratory Values, Blood Parameters, and Sevoflurane Requirements Associated with the Surgical Technique

“…Similar to the results obtained by Shih et al [ 27 ], our study did not find more requirements associated with the PNP. It may be associated with the use of low IAP values which should be better tolerated by the patients [ 22 ].…”

“…This is especially important in prolonged procedures or in high-risk patients with previous cardiorespiratory and metabolic pathologies. Although the insufflation of the abdominal cavity with CO 2 has been associated with numerous physiological and pathological changes, it has been proven that the use of low IAP [ 22 ], in addition to an adequate selection of the parameters in the positive pressure ventilation, could allow the patients to physiologically respond, thus reducing the perioperative complications [ 20 , 30 ]. In conclusion, the results of our study suggested that local and systemic alterations related to PNP in LAP Ove seemed to be reversible after CO 2 deflation and well-tolerated by healthy patients.…”

“…Another critical event is associated with the insufflation of CO 2 and its absorption through the abdominal cavity, which may produce acid-base and cardiorespiratory disturbances [ 21 ]. Presently, it is well-known that the severity of these alterations is positively correlated with higher IAP pressures [ 22 , 23 ]. For that reason, the current veterinary literature supports the use of IAP of maximum 10 mmHg in dogs [ 24 , 25 ] and below 6–8 mmHg in cats [ 26 , 27 , 28 ].…”

Use of a new device for gasless endosurgery in a laparoscopic diaphragmatic hernia repair ex vivo canine model: A pre‐clinical study

“…The establishment and maintenance of capnoperitoneum during laparoscopy may cause hypercapnia, acidosis, reduction in cardiac output, decreased pulmonary compliance, hypothermia, and post‐operative pain (Scott et al., 2020 ), as well as accidental bowel injury by Veress needle or trocar insertion (Anderson & Fransson, 2019 ). Moreover, CO 2 insufflation may trigger clinically relevant neurohumoral responses.…”

“…Thus, gasless laparoscopy (or lift laparoscopy) was developed to reduce pneumoperitoneum‐related changes. In gasless laparoscopy, working space could be created by lifting the abdominal wall with specific devices (Brun et al., 2019 ; Fransson & Ragle, 2011 ; Fransson et al., 2015 ; Scott et al., 2020 ).…”