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Comparison Between Carbon Dioxide Pneumoperitoneum and Gasless Laparoscopy

Svend Schulze, MD, DMSc; Karen Marie Lyng, MD; Kim Bugge, MD; Anders Perner, MD; Asger Bendtsen, MD; Jens Thorup, MD; Hans Jørgen Nielsen, MD, DMSc; Verner Rasmussen, MD; Jacob Rosenberg, MD, DMSc

Arch Surg. 1999;134:1112-1118.

Hypothesis  Gasless laparoscopy produces smaller cardiopulmonary and systemic changes than carbon dioxide (CO₂) laparoscopy during colonic surgery.

Design  Prospective randomized trial.

Setting  Department of Surgery in a university hospital.

Patients  Twenty-two patients scheduled for laparoscopic colonic resection; 5 patients were excluded because of conversion to open surgery (N=17).

Interventions  Patients were randomized to either gasless (n=9) or conventional CO₂ (n=8) surgery.

Main Outcome Measures  Intraoperative assessment of hemodynamic factors and pulmonary function, and postoperative assessment of pain, pulmonary function, convalescence, and various injury factors were done several times until 30 days after surgery. Surgical complications were noted.

Results  Descending aorta blood flow after 30 minutes (P=.03) and heart rate after 150 minutes were higher in the CO₂ group (P=.009). Central venous pressure, PaCO_2, inspiration pressure, and end tidal CO₂ level were significantly higher in the CO₂group (P=.05, .03, .04, and .01, respectively). Patients in the CO₂group had less pain during mobilization and coughing (P=.008 and .006, respectively), and were significantly more fatigued (P=.04). No other important differences were observed in intraoperative hemodynamic factors, postoperative convalescence, immunocompetence, or pulmonary function.

Conclusion  No clinically important differences in cardiovascular and systemic response were observed between patients undergoing CO₂or gasless laparoscopy for colonic disease.

From the Departments of Surgery (Drs Schulze, Lyng, Thorup, and Rosenberg) and Anesthesiology (Drs Bugge, Perner, and Bendtsen), Sundby Hospital; Department of Anesthesiology, Rigshospitalet (Drs Bugge and Perner); and Department of Surgical Gastroenterology (Drs Nielsen and Rosenberg) and Holter Laboratory, Department of Cardiology (Dr Rasmussen), Hvidovre Hospital, Copenhagen Hospital Cooperation, Copenhagen, Denmark.

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