Effect of body habitus and parity on insufflated CO2 volume at various intraabdominal pressures during laparoscopic access in women.
OBJECTIVE
To determine height, weight, body mass index (BMI), parity, and age effect on the volume of CO2 pneumoperitoneum during laparoscopic access in women.


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


METHODS
University-affiliated teaching hospital.


METHODS
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 (1.45-1.85 m), 70 kg (43-118 kg), 25.5 kg/m2 (17-39 kg/m2), 1.1 (0-5), and 34 years (19-58 years), respectively.


METHODS
While in supine position, patients received general endotracheal anesthesia and muscle relaxants. Pneumoperitoneum was established by reusable Veres needle. The insufflated CO2 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.


RESULTS
The mean (SD) insufflated CO2 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 CO2 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 CO2 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 CO2 insufflated volume regardless of women's age, parity, and body habitus.
Abu-Rafea
Basim
B
St. Joseph's Health Care, Department of Obstetrics and Gynecology, The University of Western Ontario, London, Ontario, Canada. baburafea@gmail.com
Vilos
George A
GA
Vilos
Angelos G
AG
Hollett-Caines
Jackie
J
Al-Omran
Mohammad
M
D034841:Abdominal Cavity / Q000503:physiopathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D001837:Body Weights and Measures; D002245:Carbon Dioxide; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery; D006785:Hospitals, University; D006801:Humans; D007327:Insufflation; D010535:Laparoscopy; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011312:Pressure; D011446:Prospective Studies; D017584:Reproductive History
D002245:Carbon Dioxide