Pneumoperitoneum in Veterinary Laparoscopy: A Review.

Jacqueline Scott,Alexander Valverde,Ameet Singh

doi:10.3390/vetsci7020064

Jacqueline Scott, Alexander Valverde + Show 1 more

Open Access

https://doi.org/10.3390/vetsci7020064

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Abstract

Objective: To review the effects of carbon dioxide pneumoperitoneum during laparoscopy, evaluate alternative techniques to establishing a working space and compare this to current recommendations in veterinary surgery. Study Design: Literature review. Sample Population: 92 peer-reviewed articles. Methods: An electronic database search identified human and veterinary literature on the effects of pneumoperitoneum (carbon dioxide insufflation for laparoscopy) and alternatives with a focus on adaptation to the veterinary field. Results: Laparoscopy is the preferred surgical approach for many human and several veterinary procedures due to the lower morbidity associated with minimally invasive surgery, compared to laparotomy. The establishment of a pneumoperitoneum with a gas most commonly facilitates a working space. Carbon dioxide is the preferred gas for insufflation as it is inert, inexpensive, noncombustible, colorless, excreted by the lungs and highly soluble in water. Detrimental side effects such as acidosis, hypercapnia, reduction in cardiac output, decreased pulmonary compliance, hypothermia and post-operative pain have been associated with a pneumoperitoneum established with CO2 insufflation. As such alternatives have been suggested such as helium, nitrous oxide, warmed and humidified carbon dioxide and gasless laparoscopy. None of these alternatives have found a consistent benefit over standard carbon dioxide insufflation. Conclusions: The physiologic alterations seen with CO2 insufflation at the current recommended intra-abdominal pressures are mild and of transient duration. Clinical Significance: The current recommendations in veterinary laparoscopy for a pneumoperitoneum using carbon dioxide appear to be safe and effective.

Highlights

The first described use of a light source to visualize a human orifice was in 1805 by Philip Bozzini to visualize the urethra and urinary bladder [1]
A literature search was conducted through the Medline and PubMed database from 1975 to 2018 using the search terms laparoscopy, capnoperitoneum, pneumoperitoneum, veterinary, dog and cat
In particular mechanical ventilation with close monitoring of end-tidal CO2 (ETCO2), blood pressure, and blood gas alterations is recommended

Summary

Introduction

The first described use of a light source to visualize a human orifice was in 1805 by Philip Bozzini to visualize the urethra and urinary bladder [1]. The first reported use of endoscopy examination of the peritoneal cavity (laparoscopy) came 1901 by Dr Kelling, using oxygen to create a pneumoperitoneum [1]. It was not until 1924 that carbon dioxide (CO2 ) was proposed as the preferred gas for insufflation [1]. Modern laparoscopy was pioneered by gynecologists in the 1960s and 1970s, it was not until the 1980s that laparoscopic surgery started to be more widely accepted [1]. Laparoscopic surgery has been found by multiple systematic reviews to reduce postoperative discomfort and shorten hospitalization times in people [2,3,4]

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