Does intraabdominal pressure affect development of subcutaneous emphysema at gynecologic laparoscopy?

Abstract

STUDY OBJECTIVE:

To estimate the effect of intraabdominal pressure and risk factors related to the occurrence of subcutaneous emphysema during laparoscopic surgery.

DESIGN:

Prospective randomized study (Canadian Task Force classification I).

SETTING:

University hospital.

PATIENTS:

Two hundred patients who underwent gynecologic laparoscopy because of benign gynecologic disease or cervical intraepithelial neoplasia.

INTERVENTIONS:

Gynecologic laparoscopy.

MEASUREMENTS AND MAIN RESULTS:

Before surgery, patients were divided randomly into 2 groups. During surgery, the first group were limited to 12 mm Hg intraabdominal pressure (n = 100), and the second group 10 mm Hg intraabdominal pressure (n = 100). The incidence of subcutaneous emphysema in each group and the relationship between subcutaneous emphysema and operation time, table tilt angle, patient age, body mass index (BMI) and end-tidal CO(2) (ETco(2)) were analyzed. The occurrence of subcutaneous emphysema was significantly lower in the group 2 than in group 1 (p = .02). The BMI was significantly lower (p = .02), and peak ETco(2) significantly higher (p < .001) in the group in which subcutaneous emphysema developed. However, there were no significant differences in age, operative time, table tilt angle, number of ports used, and initial ETco(2) between the groups with and without subcutaneous emphysema.

CONCLUSIONS:

The incidence of subcutaneous emphysema increased with higher intraabdominal pressure during gynecology laparoscopy. Low BMI and increased intraoperative ETco(2) concentration were also related to the occurrence of subcutaneous emphysema.

• Authors: Dae Woo Lee, Min Jung Kim, Yoon Kyung Lee, Hae Nam Lee
• Journal: Journal of minimally invasive gynecology (J Minim Invasive Gynecol) 2011 Nov-Dec Vol. 18 Issue 6 Pg. 761-5 ISSN: 1553-4669 [Electronic] United States
• PMID: 21940220 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.

Topics

• Abdominal Cavity (surgery)
• Adult
• Female
• Gynecologic Surgical Procedures (adverse effects)
• Humans
• Laparoscopy (adverse effects)
• Middle Aged
• Pressure
• Prospective Studies
• Subcutaneous Emphysema (etiology)