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Surgical Endoscopy

, Volume 27, Issue 5, pp 1668–1673 | Cite as

Optimizing working space in porcine laparoscopy: CT measurement of the effects of intra-abdominal pressure

  • John Vlot
  • Rene Wijnen
  • Robert Jan Stolker
  • Klaas Bax
Article

Abstract

Background

Several factors may affect volume and dimensions of the working space in laparoscopic surgery. The precise impact of these factors has not been well studied. In a porcine model, we used computed tomographic (CT) scanning for measuring working space volume and distances. In a first series of experiments, we studied the relationship between intra-abdominal pressure (IAP) and working space.

Methods

Eleven 20 kg pigs were studied under standardized anesthesia and volume-controlled ventilation. Cardiorespiratory parameters were monitored continuously, and blood gas samples were taken at different IAP levels. Respiratory rate was increased when ETCO2 exceeded 7 kPa. Breath-hold CT scans were made at IAP levels of 0, 5, 10, and 15 mmHg. Insufflator volumes were compared to CT-measured volumes. Maximum dimensions of pneumoperitoneum were measured on reconstructed CT images.

Results

Respiratory rate had to be increased in three animals. Mild hypercapnia and acidosis occurred at 15 mmHg IAP. Peak inspiratory pressure rose significantly at 10 and 15 mmHg. CT-measured volume increased relatively by 93 % from 5 to 10 mmHg IAP and by 19 % from 10 to 15 mmHg IAP. Comparing CT volumes to insufflator volumes gave a bias of 76 mL. The limits of agreement were −0.31 to +0.47, a range of 790 mL. The internal anteroposterior diameter increased by 18 % by increasing IAP from 5 to 10 mmHg and by 5 % by increasing IAP from 10 to 15 mmHg. At 15 mmHg, the total relative increase of the pubis–diaphragm distance was only 6 %. Abdominal width did not increase.

Conclusions

CT allows for precise calculation of the actual CO2 pneumoperitoneum volume, whereas the volume of CO2 released by the insufflator does not. Increasing IAP up to 10 mmHg achieved most gain in volume and in internal anteroposterior diameter. At an IAP of 10 mmHg, higher peak inspiratory pressure was significantly elevated.

Keywords

Animal model CO2 Computed tomography Laparoscopy Pneumoperitoneum Working space 

Notes

Acknowledgments

We thank P. Specht for assistance in the experiments and M. Dijkshoorn for CT scanning.

Disclosures

John Vlot, Rene Wijnen, Robert Jan Stolker, and Klaas Bax have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • John Vlot
    • 1
  • Rene Wijnen
    • 1
  • Robert Jan Stolker
    • 2
  • Klaas Bax
    • 1
  1. 1.Department of Pediatric SurgeryErasmus University Medical CentreRotterdamThe Netherlands
  2. 2.Department of AnesthesiologyErasmus University Medical CentreRotterdamThe Netherlands

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