title: Subcutaneous emphysema--beyond the pneumoperitoneum.
abstract: BACKGROUND
  Subcutaneous emphysema and gas extravasation outside of the peritoneal cavity during laparoscopy has consequences. Knowledge of the circumstances that increase the potential for subcutaneous emphysema is necessary for safe laparoscopy.
  
  
  METHODS
  A literature review and a PubMed search are the basis for this review.
  
  
  CONCLUSIONS
  The known risk factors leading to subcutaneous emphysema during laparoscopy are multiple attempts at abdominal entry, improper cannula placement, loose fitting cannula/skin and fascial entry points, use of >5 cannulas, use of cannulas as fulcrums, torque of the laparoscope, increased intra-abdominal pressure, procedures lasting >3.5 hours, and attention to details. New additional risk factors acting as direct factors leading to subcutaneous emphysema risk and occurrence are total gas volume, gas flow rate, valveless trocar systems, and robotic fulcrum forces. Recognizing this spectrum of factors that leads to subcutaneous emphysema will yield greater patient safety during laparoscopic procedures.
authors.affiliation: Biomedical Engineering, Mercer University, 109 Preston Court, Macon GA 31210, USA. gabiomed@mindspring.com.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Ott
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D013352:Subcutaneous Emphysema / Q000209:etiology*