High-pressure laparoscopic entry does not adversely affect cardiopulmonary function in healthy women

Abstract

Study objective: To determine hemodynamic and pulmonary compliance changes during laparoscopic entry using transient hyperinsufflated pneumoperitoneum.

Design: Prospective observational cohort study (Canadian Task Force classification II-1).

Setting: University-affiliated teaching hospital.

Subjects: From January through June 2004 one hundred healthy women underwent operative laparoscopy consecutively. Indications included chronic pelvic pain (CPP, N=66), pelvic mass (N=7), CPP and pelvic mass (N=4), primary or secondary infertility (N=23). The mean age was 34 years (range, 19-58) and the mean BMI 25.5 kg/m2 (range, 17.1-39.4).

Interventions: With the patients under general anesthesia, muscle relaxants, and in supine position, pneumoperitoneum was established using a Veres needle. The following information was prospectively collected at different intraperitoneal insufflation pressures (IPIP): CO2 volume, heart rate, blood pressure, and pulmonary compliance. At IPIP of 30 mm Hg the primary trocar was inserted and the IPIP was immediately reduced back to the operating pressure of 15 mm Hg.

Measurements and main results: The mean initial IPIP was 4.7 mm Hg (range, 2-9 mm Hg). The mean volume of CO2 at IPIP of 10, 15, 20, 25, and 30 mm Hg was 1.7, 3.1, 4, 4.4, and 4.7 L, respectively. There was no statistically significant change in the heart rate or pulse pressure between IPIP of 15 and 30 mm Hg. The difference in CO2 volume (1.6 L) required to achieve IPIP of 15 and 30 mm Hg was statistically significant (p<0.0001). A statistically significant increase of 7 mm Hg in the mean arterial pressure (MAP) was found between IPIP of 15 & 30 mm Hg (p<0.0001). The additional 21% drop in pulmonary compliance from IPIP 15 to 30 mm Hg was statistically significant (p<0.0001). This decrease in pulmonary compliance was well tolerated by the patients, and the oxygen saturation remained above 92% in all cases. The elevated MAP was not clinically significant.

Conclusion: The use of transient hyperinsufflated pneumoperitoneum caused minor hemodynamic alterations which were not clinically significant. The alterations in pulmonary compliance were statistically significant; however, they had no clinical significance and were tolerated well by healthy women.