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

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Abstract

Aim

The aim of this work is to analyze, by means of noninvasive monitoring, the clinical effects of high intraperitoneal pressure for enough time to insert the first trocar.

Methods

Sixty-seven patients without significant lung problems were randomly divided into groups P12 (n = 30, maximum intraperitoneal pressure 12 mmHg) and P20 (n = 37, maximum intraperitoneal pressure 20 mmHg). A Veress needle was inserted into the left hypochondrium for creation of pneumoperitoneum. The parameters evaluated were heart rate (HR, in bpm), arterial oxygen saturation (SaO2, expressed as percentage of hemoglobin saturated with oxygen), end-tidal CO2 (ETCO2, in mmHg), mean arterial pressure (MAP, in mmHg), and intratracheal pressure (ITP, in cmH2O). Clinical parameters were evaluated in both groups at time point 0 (TP0, before CO2 insufflation), time point 1 (TP1, when intraperitoneal pressure of 12 mmHg was reached in both groups), time point 2 (TP2, 5 min after reaching intraperitoneal pressure of 12 mmHg in group P12 and of 20 mmHg in group P20), and time point 3 (TP3, 10 min after reaching intraperitoneal pressure of 12 mmHg in group P12 and 10 min after TP1 in group P20, when intraperitoneal pressure decreased from 20 to 12 mmHg). Values outside of the normal range or occurrence of atypical phenomena suggestive of organic disease indicated clinical changes.

Results

Statistically significant differences were observed between the two groups regarding HR, MAP, ETCO2, and ITP. No significant clinical changes were observed.

Conclusions

Transitory, high intraperitoneal pressure (20 mmHg for 5 min) for insertion of the first trocar resulted in changes in HR, MAP, ETCO2, 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.

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Disclosures

Doctors Octavio Hypolito, João Azevedo, Fabiana Caldeira, Otavio Azevedo, Susana Miyahira, Gustavo Miguel, Otavio Becker Jr, Afonso Machado, Gilberto Nunes Filho, and Glicia Azevedo have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Operative Techniques and Experimental Surgery, Department of Surgery, Federal University of Sao Paulo, RuaBotucatu 740, Vila Clementino, Sao Paulo, SP, CEP 04023900, Brazil

    Octávio Henrique Mendes Hypólito, João Luiz Moreira Coutinho Azevedo, Fabiana Mara Scarpelli de Lima Alvarenga Caldeira, Otávio Cansanção de Azevedo, Susana Abe Miyahira, Gustavo Peixoto Soares Miguel, Otávio Monteiro Becker Jr., Afonso Cesar Cabral Guedes Machado, Gilberto Pinheiro Nunes Filho & Glícia Cansanção Azevedo

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  1. Octávio Henrique Mendes Hypólito
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  2. João Luiz Moreira Coutinho Azevedo
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  3. Fabiana Mara Scarpelli de Lima Alvarenga Caldeira
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  4. Otávio Cansanção de Azevedo
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  5. Susana Abe Miyahira
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  6. Gustavo Peixoto Soares Miguel
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  7. Otávio Monteiro Becker Jr.
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  8. Afonso Cesar Cabral Guedes Machado
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  10. Glícia Cansanção Azevedo
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Correspondence to João Luiz Moreira Coutinho Azevedo.

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Hypólito, O.H.M., Azevedo, J.L.M.C., de Lima Alvarenga Caldeira, F.M.S. et al. Creation of pneumoperitoneum: noninvasive monitoring of clinical effects of elevated intraperitoneal pressure for the insertion of the first trocar. Surg Endosc 24, 1663–1669 (2010). https://doi.org/10.1007/s00464-009-0827-2

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  • DOI: https://doi.org/10.1007/s00464-009-0827-2

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