title: Influence of pneumoperitoneum pressure on surgical field during robotic and laparoscopic surgery: a comparative study.
abstract: OBJECTIVE
  Studies on the influence of CO₂ pneumoperitoneum on the abdominal cavity during robotic procedures are lacking. This is the first study to evaluate surgical field modifications related to CO₂ pressure, during laparoscopic and robotic surgery.
  
  
  METHODS
  Consecutive patients scheduled for laparoscopic or robotic hysterectomy were enrolled in the study. To evaluate the level of operative field visualization, a dedicated form has been designed based on the evaluation of four different areas: Douglas space, vesico-uterine fold and, bilaterally, the broad ligament. During the initial inspection, an assistant randomly set the CO₂ pressure at 15, 10 and 5 mmHg, and the surgeon, not aware of the CO₂ values, was asked to give an evaluation of the four areas for each set pressure.
  
  
  RESULTS
  In laparoscopic group, CO₂ pressure significantly influenced the surgical field visualization in all four areas analyzed. The surgeon had a good visualization only at 15 mmHg CO₂ pressure; visualization decreased with a statistically significant difference from 15 to 5, 15-10 and 10-5 mmHg. In robotic group, influence of CO₂ pressure on surgical areas visualization was not straightforward; operative field visualization remained stable at any pressure value with no significant difference.
  
  
  CONCLUSIONS
  Pneumoperitoneum pressure significantly affects the visualization of the abdomino-pelvic cavity in laparoscopic procedures. Otherwise, CO₂ pressure does not affect the visualization of surgical field during robotic surgery. These findings are particularly significant especially at low CO₂ pressure with potential implications on peritoneal environment and the subsequent post-operative patient recovery.
authors.affiliation: Department of Obstetrics and Gynecology, "Campus Bio-Medico" University of Rome, Via Álvaro Del Portillo, 200-00128, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Angioli
authors.forename: Corrado
authors.initials: C
authors.lastname: Terranova
authors.forename: Francesco
authors.initials: F
authors.lastname: Plotti
authors.forename: Ester Valentina
authors.initials: EV
authors.lastname: Cafà
authors.forename: Paolo
authors.initials: P
authors.lastname: Gennari
authors.forename: Roberto
authors.initials: R
authors.lastname: Ricciardi
authors.forename: Alessia
authors.initials: A
authors.lastname: Aloisi
authors.forename: Andrea
authors.initials: A
authors.lastname: Miranda
authors.forename: Roberto
authors.initials: R
authors.lastname: Montera
authors.forename: Carlo
authors.initials: C
authors.lastname: De Cicco Nardone
mesh_terms: D000005:Abdomen / Q000601:surgery; D034841:Abdominal Cavity; D000328:Adult; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011312:Pressure; D012371:Robotics; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide