Retroperitoneoscopic surgery is not associated with increased carbon dioxide absorption

Purpose: Previous studies have suggested that retroperitoneal laparoscopy i s associated with greater carbon dioxide absorption and related postoperati ve morbidity, such as subcutaneous emphysema and pneumothorax. We prospecti vely compared the effects of carbon dioxide absorption during transperitone al and retroperitoneal laparoscopic renal and adrenal surgery at our instit ution. Materials and Methods: Data were collected prospectively on 51 patients who underwent laparoscopic renal (26) or adrenal (25) surgery via the transper itoneal (18) or retroperitoneal (33) approach from September 1997 to Februa ry 1998. Results: There was no significant difference in carbon dioxide elimination in patients who underwent transperitoneal laparoscopy compared to retroperi toneoscopy at any interval. Subcutaneous emphysema occurred in 12.5% of the transperitoneal and 45% of the retroperitoneal group (p = 0.09). Patients with subcutaneous emphysema had greater carbon dioxide elimination during t he first 2.5 hours of insufflation compared to those without subcutaneous e mphysema and, thereafter, carbon dioxide elimination decreased to baseline. Conclusions: In contrast to previous reports our prospective nonrandomized study suggests that retroperitoneoscopy is not associated with greater carb on dioxide absorption compared to transperitoneal laparoscopy. Patients wit h subcutaneous emphysema exhibited only transient increases in carbon dioxi de absorption above control levels.