Effect of body habitus and parity on insufflated CO 2 volume at various intraabdominal pressures during laparoscopic access in women

Abstract

Study objective To determine height, weight, body mass index (BMI), parity, and age effect on the volume of CO 2 pneumoperitoneum during laparoscopic access in women. Design Prospective observational cohort study (Canadian Task Force classification II-1). Setting University-affiliated teaching hospital. Patients From January through June 2004, 100 healthy women underwent operative laparoscopic surgery consecutively by the senior author (GAV). Indications were: chronic pelvic pain (CPP, n = 66), pelvic mass (n = 7), CPP and pelvic mass (n = 4), infertility (n = 23). Median (range) height, weight, BMI, parity and age were 1.65 m (1.45–1.85m), 70 kg (43–118 kg), 25.5 kg/m 2 (17–39 kg/m 2), 1.1 (0–5), and 34 years (19–58 years), respectively. Interventions While in supine position, patients received general endotracheal anesthesia and muscle relaxants. Pneumoperitoneum was established by reusable Veres needle. The insufflated CO 2 volume was serially recorded at intraperitoneal insufflation pressures (IPIPs) of 10, 15, 20, 25, and 30 mm Hg. The primary 10-mm trocar was introduced at IPIP of 30 mm Hg. Upon entering the peritoneal cavity, the abdominal contents were visualized with the laparoscope to ensure there was no injury, and the IPIP was immediately reduced back to the operating pressure of 15 mm Hg before switching the patient to the Trendelenburg position. Measurements and main results The mean (SD) insufflated CO 2 volumes at 10, 15, 20, 25, and 30 mm Hg were 1.7 (0.74) L, 3.1 (0.9) L, 3.96 (1.05) L, 4.42 (1.1) L and 4.72 (1.14) L, respectively. Using multivariate analysis, we demonstrated that at 20 to 30 mm Hg the insufflated CO 2 volume correlated positively with the height, weight and BMI of women. Parity correlated positively at all pressures. There was no correlation with age at any pressure. Conclusions Higher CO 2 volume is required to establish appropriate pneumoperitoneum in tall, overweight, and parous women at 20 to 30 mm Hg. Setting the IPIP at 20 to 30 mm Hg before primary trocar insertion eliminates the need to monitor CO 2 insufflated volume regardless of women’s age, parity, and body habitus.