Comparison of Carbon Dioxide Absorption Rates in Gynecologic Laparoscopy with a Valveless versus Standard Insufflation System: Randomized Controlled Trial

J Minim Invasive Gynecol. 2020 Jan;27(1):225-234. doi: 10.1016/j.jmig.2019.05.005. Epub 2019 May 21.

Abstract

Study objective: The primary objective was to compare carbon dioxide (CO2) absorption rates in patients undergoing gynecologic laparoscopy with a standard versus valveless insufflation system (AirSeal; ConMed, Utica, NY) at intra-abdominal pressures (IAPs) of 10 and 15 mm Hg. Secondary objectives were assessment of surgeons' visualization of the operative field, anesthesiologists' ability to maintain adequate end-tidal CO2 (etCO2), and patients' report of postoperative shoulder pain.

Design: A randomized controlled trial using an equal allocation ratio into 4 arms: standard insufflation/IAP 10 mm Hg, standard insufflation/IAP 15 mm Hg, valveless insufflation/IAP 10 mm Hg, and valveless insufflation/IAP 15 mm Hg.

Setting: Single tertiary care academic institution.

Patients: Women ≥ 18 years old undergoing nonemergent conventional or robotic gynecologic laparoscopic surgery.

Interventions: A standard or valveless insufflation system at IAPs of 10 or 15 mm Hg.

Measurements and main results: One hundred thirty-two patients were enrolled and randomized with 33 patients per group. There were 84 robotic cases and 47 conventional laparoscopic cases. CO2 absorption rates (mL/kg*min) did not differ across groups with mean rates of 4.00 ± 1.3 in the valveless insufflation groups and 4.00 ± 1.1 in the standard insufflation groups. The surgeons' rating of overall visualization of the operative field on a 10-point Likert scale favored the valveless insufflation system (median visualization, 9.0 ± 2.0 cm and 9.5 ± 1.8 cm at 10 and 15 mm Hg, respectively) over standard insufflation (7.0 ± 3.0 cm and 7.0 ± 2.0 cm at 10 and 15 mm Hg, respectively; p <.001). The anesthesiologists' ability to maintain adequate etCO2 was similar across groups (p = .417). Postoperative shoulder pain scores were low overall with no significant difference across groups (p >.05).

Conclusion: CO2 absorption rates, anesthesiologists' ability to maintain adequate etCO2, and postoperative shoulder pain did not differ based on insufflation system type or IAP. Surgeons' rating of visualization of the operative field was significantly improved when using the valveless over the standard insufflation system.

Keywords: Carbon dioxide (CO(2)) absorption; Insufflation; Laparoscopy; Shoulder pain.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Carbon Dioxide / adverse effects
  • Carbon Dioxide / pharmacokinetics*
  • Female
  • Gastrointestinal Absorption
  • Gynecologic Surgical Procedures* / adverse effects
  • Gynecologic Surgical Procedures* / methods
  • Gynecologic Surgical Procedures* / standards
  • Humans
  • Insufflation* / adverse effects
  • Insufflation* / instrumentation
  • Insufflation* / methods
  • Insufflation* / standards
  • Laparoscopy / adverse effects
  • Laparoscopy / methods*
  • Middle Aged
  • Pain, Postoperative / etiology
  • Postoperative Complications / etiology
  • Pressure
  • Robotic Surgical Procedures / adverse effects
  • Robotic Surgical Procedures / instrumentation
  • Robotic Surgical Procedures / methods
  • Robotic Surgical Procedures / standards
  • Shoulder Pain / etiology
  • Surgical Instruments / standards
  • Treatment Outcome

Substances

  • Carbon Dioxide