LAPAROSCOPIC PNEUMOPERITONEUM - IMPACT OF BODY HABITUS

The purpose of this study was to determine the relationships among pne umoperitoneum pressure, CO2 insufflation volume, and patient height, w eight, and body mass index. Forty-one male patients undergoing laparos copic urologic procedures prospectively had a record made of the deliv ered volume of CO2 during insufflation to attain intraabdominal pressu res of 5, 10, 15, 20, 25, and 30 mm Hg. The relationship of the delive red volume of CO2 insufflated and the intraabdominal pressure was comp ared statistically to the patient height, weight, and body mass index. In addition, six domestic female pigs underwent pneumoperitoneum, and the abdominal volume was calculated for intraabdominal pressures of 0 , 5, 10, 15, 20, 25, and 30 mm Hg. Four different commercially availab le 10-mm trocars were tested for force required for placement at intra abdominal pressures of 15 and 30 mm Hg. There was a direct relationshi p between delivered volume of CO2 insufflated and the pneumoperitoneum pressure. There was no significant relationship between the delivered volume of CO2 insufflated at a given intraabdominal pressure and the patient height, weight, or body mass index. During insufflation, 94% o f the abdominal volume is achieved by insufflating to 15 mm Hg. There is no significant difference in the force required for insertion of di fferent ports at 15 mm vs 30 mm Hg pressure. Increasing the abdominal pressure to 30 mm Hg provides a 50% increase in the volume of CO2 insu fflated vs a standard 15 mm Hg pneumoperitoneum. However, this additio nal volume does not significantly change the actual abdominal volume o r diminish the pressure necessary to insert a trocar.