Insufflation

Following abdominal entry, gas insufflation (generally using carbon dioxide) lifts the abdominal wall away from the abdominal contents, allowing visualization and space in which to operate.

This pneumoperitoneum does result in cardiovascular and respiratory changes relating to increased intra-abdominal pressures and hypercarbia from absorption of carbon dioxide. The increased intra-abdominal pressure may lead to an increase in systemic vascular resistance, increasing afterload and decreasing cardiac output, and the upward diaphragmatic shift decreases the functional residual capacity of the lungs (51, 52). The high solubility of carbon dioxide results in rapid absorption into the circulation and hypercarbia may result in acidosis, decreasing cardiac contractility. Pneumoperitoneum may also compress the renal vasculature and parenchyma resulting in activation of the renin-angiotensin system and renal vasoconstriction (51). The significance of these effects depends on the intra-abdominal pressures achieved, patient positioning, duration of pneumoperitoneum, and the woman's preoperative cardiac and respiratory function (52).

Several prospective studies have been undertaken in the gynaecological setting to determine the effect on cardiorespiratory function at a relatively high intraperitoneal pressure of 25 mm (used commonly at laparoscopic entry) which report no adverse cardiopulmonary events in more than 4000 women having gynaecological surgery with pressures at entry of 25-30 mmHg (35, 53, 54).

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Source: Arulkumaran S., Ledger W., Denny L., Doumouchtsis S. (eds.). Oxford Textbook of Obstetrics and Gynaecology. Oxford University Press,2020. — 928 p.. 2020

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