title: Compliance of the abdominal wall during laparoscopic insufflation.
abstract: To provide adequate workspace between the viscera and abdominal wall, insufflation with carbon dioxide is a common practice in laparoscopic surgeries. An insufflation pressure of 15 mmHg is considered to be safe in patients, but all insufflation pressures create perioperative and postoperative physiologic effects. As a composition of viscoelastic materials, the abdominal wall should distend in a predictable manner given the pressure of the pneumoperitoneum. The purpose of this study was to elucidate the relationship between degree of abdominal distention and the insufflation pressure, with the goal of determining factors which impact the compliance of the abdominal wall.
  
  
  
  A prospective, IRB-approved study was conducted to video record the abdomens of patients undergoing insufflation prior to a laparoscopic surgery. Photo samples were taken every 5 s, and the strain of the patient's abdomen in the sagittal plane was determined, as well as the insufflator pressure (stress) at bedside. Patients were insufflated to 15 mmHg. The relationship between the stress and strain was determined in each sample, and compliance of the patient's abdominal wall was calculated. Subcutaneous fat thickness and rectus abdominus muscle thickness were obtained from computed tomography scans. Correlations between abdominal wall compliances and subcutaneous fat and muscle content were determined.
  
  
  
  Twenty-five patients were evaluated. An increased fat thickness in the abdominal wall had a direct exponential relationship with abdominal wall compliance (R2= 0.59, p < 0.05). There was no correlation between muscle and fat thickness.
  
  
  
  All insufflation pressures create perioperative and postoperative complications. The compliance of patients' abdominal body walls differs, and subcutaneous fat thickness has a direct exponential relationship with abdominal wall compliance. Thus, insufflation pressures can be better tailored per the patient. Future studies are needed to demonstrate the clinical impact of varying insufflation pressures.
authors.affiliation: University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: Chuck
authors.initials: C
authors.lastname: Becker
authors.affiliation: Department of Surgery, University of Kentucky College of Medicine, 800 Rose Street, UKMC C-222, Lexington, KY, 40536-0298, USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Plymale
authors.affiliation: Department of Surgery, University of Kentucky College of Medicine, 800 Rose Street, UKMC C-222, Lexington, KY, 40536-0298, USA.
authors.forename: John
authors.initials: J
authors.lastname: Wennergren
authors.affiliation: Department of Surgery, University of Kentucky College of Medicine, 800 Rose Street, UKMC C-222, Lexington, KY, 40536-0298, USA.
authors.forename: Crystal
authors.initials: C
authors.lastname: Totten
authors.affiliation: University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Stigall
authors.affiliation: Department of Surgery, University of Kentucky College of Medicine, 800 Rose Street, UKMC C-222, Lexington, KY, 40536-0298, USA. jsroth2@email.uky.edu.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Roth
mesh_terms: D034841:Abdominal Cavity; D034861:Abdominal Wall / Q000502:physiology*; D002245:Carbon Dioxide; D003187:Compliance; D006801:Humans; D007327:Insufflation / Q000379:methods*; D010535:Laparoscopy; D009929:Organ Size; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011312:Pressure; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D050151:Subcutaneous Fat / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
chemical_list: D002245:Carbon Dioxide
keywords: Abdominal wall compliance; Insufflation; Laparoscopic surgery