Skip to main content
SpringerLink
Log in

Pneumothorax during laparoscopy

  • Original article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background: Pneumothorax is a known complication of laparoscopy, with most pneumothoraces diagnosed postoperatively with conventional chest x-ray. Electrocardiogram (ECG) conduction changes are associated with pneumothorax. In a sheep model, ECG changes were evaluated as a potential indicator of intraoperative pneumothorax. Additionally, resolution rates of helium (He) and carbon dioxide (CO2) pneumothorax were also evaluated in this model.Methods: Under general anesthesia, 10 sheep had known volumes (20–100 cc) of either He or CO2 introduced into the left hemithorax. A 12-lead ECG recorded changes associated with the induced pneumothorax. After changes in the ECG plateaued, the gas volume in the hemithorax was increased to 2 L and the resultant pneumothorax was followed for a 2-h period using fluoroscopy to determine resolution rates for the different gas pneumothoraces. Gas volumes were aspirated after 2 h and ECGs were again recorded.Results: Pneumothorax volumes as low as 20 cc produced consistent ECG changes. The amplitude of the precordial QRS complex was seen to diminish, and this lowering of the QRS amplitude continued as pneumothorax volume increased up to 100 cc. The ECG returned to prepneumothorax patterns with aspiration of the left chest. For different gas pneumothoraces, CO2 pneumothorax showed almost complete resolution in the 2-h period, whereas He pneumothorax was unchanged.Conclusions: Precordial ECG changes appear to be a very sensitive indicator of pneumothorax, with very small pneumothorax (<100 cc) consistently being detected by reduction of the QRS complex amplitude. Intraoperative use of precordial ECG leads could result in rapid identification of pneumothorax during laparoscopic surgery. Carbon dioxide pneumothorax shows near 100% resolution in a 2-h period. This supports recommendations of expectant management in asymptomatic patients with CO2 pneumothorax. However, He pneumothorax does not resolve spontaneously quickly and may require aspiration even in asymptomatic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. G Botz JG Brock-Utne (1992) ArticleTitleAre electrocardiogram changes the first sign of impending perioperative pneumothorax?. Anaesthesia 47 1057–1059 Occurrence Handle1:STN:280:ByyC2c3ptVw%3D Occurrence Handle1489031

    CAS  PubMed  Google Scholar 

  2. P Dieter TR Eubanks PE Omelanczuk et al. (2001) ArticleTitleManagement and outcome of complications after laparoscopic antireflux operations. Arch Surg 136 399–404 Occurrence Handle10.1001/archsurg.136.4.399 Occurrence Handle11296109

    Article  PubMed  Google Scholar 

  3. PJ Girish (2001) ArticleTitleComplications of laparoscopy. Anesth Clin North Am 19 89–105

    Google Scholar 

  4. JL Joris JD Chiche ML Lamy (1995) ArticleTitlePneumothorax during laparoscopic fundoplication: diagnosis and treatment with positive end-expiratory pressure. Anesth Analg 81 993–1000 Occurrence Handle1:STN:280:BymD28fpslY%3D Occurrence Handle7486090

    CAS  PubMed  Google Scholar 

  5. P Kuritzky AL Goldfarb (1976) ArticleTitleUnusual electrocardiographic changes in spontaneous pneumothorax. Chest 70 535–537 Occurrence Handle1:STN:280:CSiD38rjtlw%3D Occurrence Handle975956

    CAS  PubMed  Google Scholar 

  6. MT Makinen A Yli-Hankala M Kansanaho (1995) ArticleTitleEarly detection of CO2 pneumothorax with continuous spirometry during laparoscopic fundoplication. Acta Anaesthesiol Scand 39 411–413 Occurrence Handle1:STN:280:ByqA3MzltFE%3D Occurrence Handle7793226

    CAS  PubMed  Google Scholar 

  7. D Mangar GT Kirchhoff JJ Leal R Laborde E Fu (1994) ArticleTitlePneumothorax during laparoscopic Nissen fundoplication. Can J Anesth 41 854–856 Occurrence Handle1:STN:280:ByqD2c3ps1w%3D

    CAS  Google Scholar 

  8. CM Murdock AJ Wolff T Van Geem (2000) ArticleTitleRisk factors for hypercarbia, subcutaneous emphysema, pneumothorax and pneumomediastinum during laparoscopy. Obstet Gynecol 95 704–709

    Google Scholar 

  9. SJ Neuhaus A Gupta DI Watson (2001) ArticleTitleHelium and other alternative gases for laparoscopy. Surg Endosc 15 553–560 Occurrence Handle10.1007/s004640080060 Occurrence Handle1:STN:280:DC%2BD3MrksV2guw%3D%3D Occurrence Handle11591939

    Article  CAS  PubMed  Google Scholar 

  10. DI Watson GG Jamieson R Britten-Jones et al. (1993) ArticleTitlePneumothorax during laparoscopic dissection of the diaphragmatic hiatus. Br J Surg 80 1353–1354 Occurrence Handle1:STN:280:ByuD287kvVI%3D

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    R. Ludemann, R. Krysztopik & G. G. Jamieson

  2. Department of Surgery, Flinders University, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia

    D. I. Watson

Authors
  1. R. Ludemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Krysztopik
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. G. Jamieson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. I. Watson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. I. Watson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ludemann, R., Krysztopik, R., Jamieson, G. et al. Pneumothorax during laparoscopy . Surg Endosc 17, 1985–1989 (2003). https://doi.org/10.1007/s00464-003-8126-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-003-8126-9

Keywords

Search

Navigation