Abstract
Laparoscopy and robotic surgery have evolved in the last 30 years of minimally invasive surgery, and several authors have described the outcomes of these surgical approaches in different specialties. In this scenario, the importance of a surgeon’s familiarity with the physiologic principles of pneumoperitoneum and its effects on the patient is crucial to avoid complications and optimize operative outcomes. This chapter describes the basic physiology of pneumoperitoneum and potential complications arising from its use.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Wheeless CR. Outpatient laparoscope sterilization under local anesthesia. Obstet Gynecol. 1972;39:767.
Dubois F, Icard P, Berthelot G, et al. Coelioscopic cholecystectomy. Preliminary report of 36 cases. Ann Surg. 1990;211:60.
Clayman RV, Kavoussi LR, Soper NJ, et al. Laparoscopic nephrectomy: initial case report. J Urol. 1991;146:278.
Uhlich GA. Laparoscopy: the question of the proper gas. Gastrointest Endosc. 1982;28:212.
Menes T, Spivak H. Laparoscopy: searching for the proper insufflation gas. Surg Endosc. 2000;14:1050.
Wolf JS, Stoller ML. The physiology of laparoscopy: basic principles, complications and other considerations. J Urol. 1994;152:294.
Brackman MR, Finelli FC, Light T, et al. Helium pneumoperitoneum ameliorates hypercarbia and acidosis associated with carbon dioxide insufflation during laparoscopic gastric bypass in pigs. Obes Surg. 2003;13:768.
Sharp JR, Pierson WP, Brady CE. Comparison of CO2- and N2O-induced discomfort during peritoneoscopy under local anesthesia. Gastroenterology. 1982;82:453.
Minoli G, Terruzzi V, Spinzi GC, et al. The influence of carbon dioxide and nitrous oxide on pain during laparoscopy: a double-blind, controlled trial. Gastrointest Endosc. 1982;28:173.
Gunatilake DE. Case report: fatal intraperitoneal explosion during electrocoagulation via laparoscopy. Int J Gynaecol Obstet. 1978;15:353.
Hunter JG, Staheli J, Oddsdottir M, et al. Nitrous oxide pneumoperitoneum revisited. Is there a risk of combustion? Surg Endosc. 1995;9:501.
Diamant M, Benumof JL, Saidman LJ. Hemodynamics of increased intra-abdominal pressure: interaction with hypovolemia and halothane anesthesia. Anesthesiology. 1978;48:23.
Richardson JD, Trinkle JK. Hemodynamic and respiratory alterations with increased intra-abdominal pressure. J Surg Res. 1976;20:401.
O'Malley C, Cunningham AJ. Physiologic changes during laparoscopy. Anesthesiol Clin North Am. 2001;19:1.
McLaughlin JG, Scheeres DE, Dean RJ, et al. The adverse hemodynamic effects of laparoscopic cholecystectomy. Surg Endosc. 1995;9:121.
Dexter SP, Vucevic M, Gibson J, et al. Hemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy. Surg Endosc. 1999;13:376.
Neudecker J, Sauerland S, Neugebauer E, et al. The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc. 2002;16:1121.
Thorington J. Schmidt, CF: a study of urinary output and blood-pressure changes resulting in experimental ascites. Am J Med Sci. 1932;165:880.
Bradley SE, Bradley GP. The effect of increased intra-abdominal pressure on renal function in man. J Clin Invest. 1947;26:1010.
Harman PK, Kron IL, McLachlan HD, et al. Elevated intra-abdominal pressure and renal function. Ann Surg. 1982;196:594.
Chiu AW, Azadzoi KM, Hatzichristou DG, et al. Effects of intra-abdominal pressure on renal tissue perfusion during laparoscopy. J Endourol. 1994;8:99.
London ET, Ho HS, Neuhaus AM, et al. Effect of intravascular volume expansion on renal function during prolonged CO2 pneumoperitoneum. Ann Surg. 2000;231:195.
McDougall EM, Monk TG, Wolf JS, et al. The effect of prolonged pneumoperitoneum on renal function in an animal model. J Am Coll Surg. 1996;182:317.
Chang DT, Kirsch AJ, Sawczuk IS. Oliguria during laparoscopic surgery. J Endourol. 1994;8:349.
Kerbl K, Clayman RV, McDougall EM, et al. Laparoscopic nephrectomy: the Washington university experience. Br J Urol. 1994;73:231.
Pérez J, Taurá P, Rueda J, et al. Role of dopamine in renal dysfunction during laparoscopic surgery. Surg Endosc. 2002;16:1297.
Koivusalo AM, Kellokumpu I, Ristkari S, et al. Splanchnic and renal deterioration during and after laparoscopic cholecystectomy: a comparison of the carbon dioxide pneumoperitoneum and the abdominal wall lift method. Anesth Analg. 1997;85:886.
Caldwell CB, Ricotta JJ. Changes in visceral blood flow with elevated intraabdominal pressure. J Surg Res. 1987;43:14.
Evasovich MR, Clark TC, Horattas MC, et al. Does pneumoperitoneum during laparoscopy increase bacterial translocation? Surg Endosc. 1996;10:1176.
Irgau I, Koyfman Y, Tikellis JI. Elective intraoperative intracranial pressure monitoring during laparoscopic cholecystectomy. Arch Surg. 1995;130:1011.
Josephs LG, Este-McDonald JR, Birkett DH, et al. Diagnostic laparoscopy increases intracranial pressure. J Trauma. 1994;36:815.
Rosenthal RJ, Hiatt JR, Phillips EH, et al. Intracranial pressure. Effects of pneumoperitoneum in a large-animal model. Surg Endosc. 1997;11:376.
Fujii Y, Tanaka H, Tsuruoka S, et al. Middle cerebral arterial blood flow velocity increases during laparoscopic cholecystectomy. Anesth Analg. 1994;78:80.
Abe K, Hashimoto N, Taniguchi A, et al. Middle cerebral artery blood flow velocity during laparoscopic surgery in head-down position. Surg Laparosc Endosc. 1998;8:1.
Schöb OM, Allen DC, Benzel E, et al. A comparison of the pathophysiologic effects of carbon dioxide, nitrous oxide, and helium pneumoperitoneum on intracranial pressure. Am J Surg. 1996;172:248.
Este-McDonald JR, Josephs LG, Birkett DH, et al. Changes in intracranial pressure associated with apneumic retractors. Arch Surg. 1995;130:362.
Halverson AL, Barrett WL, Iglesias AR, et al. Decreased cerebrospinal fluid absorption during abdominal insufflation. Surg Endosc. 1999;13:797.
Ben-Haim M, Rosenthal RJ. Causes of arterial hypertension and splachnic ischemia during acute elevations in intra-abdominal pressure with CO2 pneumoperitoneum: a complex central nervous system mediated response. Int J Color Dis. 1999;14:227.
Motew M, Ivankovich AD, Bieniarz J, et al. Cardiovascular effects and acid-base and blood gas changes during laparoscopy. Am J Obstet Gynecol. 1973;115:1002.
Gutt CN, Oniu T, Mehrabi A, et al. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg. 2004;21:95.
Hardacre JM, Talamini MA. Pulmonary and hemodynamic changes during laparoscopy--are they important? Surgery. 2000;127:241.
Schwenk W, Böhm B, Witt C, et al. Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation. Arch Surg. 1999;134:6.
Hasukić S, Mesić D, Dizdarević E, et al. Pulmonary function after laparoscopic and open cholecystectomy. Surg Endosc. 2002;16:163.
Alexander GD, Brown EM. Physiologic alterations during pelvic laparoscopy. Am J Obstet Gynecol. 1969;105:1078.
Montalva M, Das B. Carbon dioxide homeostasis during laparoscopy. South Med J. 1976;69:602.
Mullett CE, Viale JP, Sagnard PE, et al. Pulmonary CO2 elimination during surgical procedures using intra- or extraperitoneal CO2 insufflation. Anesth Analg. 1993;76:622.
PRICE, H. L. Effects of carbon dioxide on the cardiovascular system. Anesthesiology. 1960;21:652.
Cullen DJ, Eger EI. Cardiovascular effects of carbon dioxide in man. Anesthesiology. 1974;41:345.
Seed RF, Shakespeare TF, Muldoon MJ. Carbon dioxide homeostasis during anaesthesia for laparoscopy. Anaesthesia. 1970;25:223.
Farhi LE, Rahn H. Dynamics of changes in carbon dioxide stores. Anesthesiology. 1960;21:604.
Wallace DH, Serpell MG, Baxter JN, et al. Randomized trial of different insufflation pressures for laparoscopic cholecystectomy. Br J Surg. 1997;84:455.
Williams MD, Murr PC. Laparoscopic insufflation of the abdomen depresses cardiopulmonary function. Surg Endosc. 1993;7:12.
Joris JL, Noirot DP, Legrand MJ, et al. Hemodynamic changes during laparoscopic cholecystectomy. Anesth Analg. 1993;76:1067.
Kelman GR, Swapp GH, Smith I, et al. Caridac output and arterial blood-gas tension during laparoscopy. Br J Anaesth. 1972;44:1155.
Chaudhary D, Verma GR, Gupta R, et al. Comparative evaluation of the inflammatory mediators in patients undergoing laparoscopic versus conventional cholecystectomy. Aust N Z J Surg. 1999;69:369.
Cho JM, LaPorta AJ, Clark JR, et al. Response of serum cytokines in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 1994;8:1380.
Glaser F, Sannwald GA, Buhr HJ, et al. General stress response to conventional and laparoscopic cholecystectomy. Ann Surg. 1995;221:372.
Harmon GD, Senagore AJ, Kilbride MJ, et al. Interleukin-6 response to laparoscopic and open colectomy. Dis Colon Rectum. 1994;37:754.
Joris J, Cigarini I, Legrand M, et al. Metabolic and respiratory changes after cholecystectomy performed via laparotomy or laparoscopy. Br J Anaesth. 1992;69:341.
Maruszynski M, Pojda Z. Interleukin 6 (IL-6) levels in the monitoring of surgical trauma. A comparison of serum IL-6 concentrations in patients treated by cholecystectomy via laparotomy or laparoscopy. Surg Endosc. 1995;9:882.
Leung KL, Lai PB, Ho RL, et al. Systemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma: a prospective randomized trial. Ann Surg. 2000;231:506.
Roumen RM, van Meurs PA, Kuypers HH, et al. Serum interleukin-6 and C reactive protein responses in patients after laparoscopic or conventional cholecystectomy. Eur J Surg. 1992;158:541.
Hill AD, Banwell PE, Darzi A, et al. Inflammatory markers following laparoscopic and open hernia repair. Surg Endosc. 1995;9:695.
Chekan EG, Nataraj C, Clary EM, et al. Intraperitoneal immunity and pneumoperitoneum. Surg Endosc. 1999;13:1135.
West MA, Baker J, Bellingham J. Kinetics of decreased LPS-stimulated cytokine release by macrophages exposed to CO2. J Surg Res. 1996;63:269.
Sietses C, von Blomberg ME, Eijsbouts QA, et al. The influence of CO2 versus helium insufflation or the abdominal wall lifting technique on the systemic immune response. Surg Endosc. 2002;16:525.
Karayiannakis AJ, Makri GG, Mantzioka A, et al. Systemic stress response after laparoscopic or open cholecystectomy: a randomized trial. Br J Surg. 1997;84:467.
Le Blanc-Louvry I, Coquerel A, Koning E, et al. Operative stress response is reduced after laparoscopic compared to open cholecystectomy: the relationship with postoperative pain and ileus. Dig Dis Sci. 2000;45:1703.
Wolf JS, Clayman RV, Monk TG, et al. Carbon dioxide absorption during laparoscopic pelvic operation. J Am Coll Surg. 1995;180:555.
Kent RB. Subcutaneous emphysema and hypercarbia following laparoscopic cholecystectomy. Arch Surg. 1991;126:1154.
Hall D, Goldstein A, Tynan E, et al. Profound hypercarbia late in the course of laparoscopic cholecystectomy: detection by continuous capnometry. Anesthesiology. 1993;79:173.
Murray DP, Rankin RA, Lackey C. Bilateral pneumothoraces complicating peritoneoscopy. Gastrointest Endosc. 1984;30:45.
Pascual JB, Baranda MM, Tarrero MT, et al. Subcutaneous emphysema, pneumomediastinum, bilateral pneumothorax and pneumopericardium after laparoscopy. Endoscopy. 1990;22:59.
Herrerías JM, Ariza A, Garrido M. An unusual complication of laparoscopy: pneumopericardium. Endoscopy. 1980;12:254.
Nicholson RD, Berman ND. Pneumopericardium following laparoscopy. Chest. 1979;76:605.
Ostman PL, Pantle-Fisher FH, Faure EA, et al. Circulatory collapse during laparoscopy. J Clin Anesth. 1990;2:129.
JERNSTROM, P. Air embolism during peritoneoscopy. Am J Clin Pathol. 1951;21:573.
O'Sullivan DC, Micali S, Averch TD, et al. Factors involved in gas embolism after laparoscopic injury to inferior vena cava. J Endourol. 1998;12:149.
Carmichael DE. Laparoscopy-cardiac considerations. Fertil Steril. 1971;22:69.
Scott DB, Julian DG. Observations on cardiac arrythmias during laparoscopy. Br Med J. 1972;1:411.
Neudecker J, Sauerland S, Neugebauer E, et al. The euro- pean association for endoscopic surgery clinical practice guide- line on the pneumoperitoneum for laparoscopic surgery. Surg Endosc. 2002;16:1121–43. https://doi.org/10.1007/s00464-001-9166-7.
Shahait M, Cockrell R, Yezdani M, et al. Improved out- comes utilizing a valveless-trocar system during robot-assisted radical prostatectomy (RARP). Jsls. 2019; https://doi.org/10.4293/jsls.2018.00085.
NeppleKG KD, Bhayani SB. Benchtop evaluation of pressure barrier insufflator and standard insufflator systems. Surg Endosc. 2013;27:333–8. https://doi.org/10.1007/s00464-012-2434-x.
Bucur P, Hofmann M, Menhadji A, et al. Comparison of pneumoperitoneum stability between a valveless trocar system and conventional insufflation: a prospective randomized trial. Urology. 2016;94:274–80. https://doi.org/10.1016/j.urology.2016.04.022.
Herati AS, Andonian S, Rais-Bahrami S, et al. Use of the valveless trocar system reduces carbon dioxide absorption during. Urology. 2011;77(5):1126–32.
Covotta M, Claroni C, Torregiani G, et al. A prospective, randomized, clinical trial on the effects of a valveless trocar on respiratory mechanics during robotic radical cystectomy: a pilot 089 study. Anesth Analg. 2017;124:1794–801. https://doi.org/10.1213/ane.0000000000002027.
George AK, Wimhofer R, Viola KV, et al. Utilization of a novel valveless trocar system during robotic-assisted laparoscopic prostatectomy. World J Urol. 2015;33:1695–9. https://doi.org/10.1007/s00345-015-1521-8.
Horstmann M, Horton K, Kurz M, et al. Prospective comparison between the AirSeal(R) system valve-less trocar and a standard Versaport plus V2 trocar in robotic-assisted radical prostatectomy. J Endourol. 2013;27:579–82. https://doi.org/10.1089/end.2012.0632.
Madueke-Laveaux OS, Advincula A, Grimes CL, et al. Comparison of carbon dioxide absorption rates in gynecologic laparoscopy with a valveless versus standard insufflation system: randomized controlled trial. J Minim Invasive Gynecol. 2020;27:225–34. https://doi.org/10.1016/j.jmig.2019.05.005.
Miyano G, Nakamura H, Seo S, et al. Pneumoperitoneum and hemodynamic stability during pediatric laparoscopic appendectomy. J Pediatr Surg. 2016;51:1949–51. https://doi.org/10.1016/j.jpedsurg.2016.09.016.
Annino F, Topazio L, Autieri D, et al. Robotic partial nephrectomy performed with Airseal versus a standard CO2 pressure pneumoperitoneum insufflator: a prospective comparative study. Surg Endosc. 2017;31:1583–90. https://doi.org/10.1007/s00464-016-5144-y.
Gurusamy KS, Samraj K, Davidson BR. Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. In: The Cochrane Collaboration, editor. Cochrane database of systematic reviews. Chichester: John Wiley; 2009.
Sroussi J, Elies A, Rigouzzo A, et al. Low pressure gynecological laparoscopy (7mmHg) with AirSeal((R)) System versus a standard insufflation (15mmHg): a pilot study in 60 patients. J Gynecol Obstet Hum Reprod. 2017;46:155–8. https://doi.org/10.1016/j.jogoh.2016.09.003.
Dalli J, Khan MF, Nolan K, Cahill RA. Laparoscopic pneumoperitoneum escape and contamination during surgery using the Airseal Insufflation System - a video vignette. Colorectal Dis. 2020 Sep;22(9):1029–1030. https://doi.org/10.1111/codi.15255. Epub 2020 Sep 1. PMID: 32644263; PMCID: PMC7362043.
Balayssac D, Selvy M, Martelin A, et al. Clinical and organizational impact of the AIRSEAL® insufflation system during laparoscopic surgery: a systematic review. World J Surg. 2021;45:705–18. https://doi.org/10.1007/s00268-020-05869-5.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Kominsky, H.D., Cadeddu, J.A., Moschovas, M.C., Leveillee, R.J. (2022). Pneumoperitoneum Physiology. In: Wiklund, P., Mottrie, A., Gundeti, M.S., Patel, V. (eds) Robotic Urologic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-00363-9_16
Download citation
DOI: https://doi.org/10.1007/978-3-031-00363-9_16
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-00362-2
Online ISBN: 978-3-031-00363-9
eBook Packages: MedicineMedicine (R0)