Does Intraabdominal Pressure Affect Development of Subcutaneous Emphysema at Gynecologic Laparoscopy?

Study ObjectiveTo estimate the effect of intraabdominal pressure and risk factors related to the occurrence of subcutaneous emphysema during laparoscopic surgery.DesignProspective randomized study (Canadian Task Force classification I).SettingUniversity hospital.PatientsTwo hundred patients who underwent gynecologic laparoscopy because of benign gynecologic disease or cervical intraepithelial neoplasia.InterventionsGynecologic laparoscopy.Measurements and Main ResultsBefore surgery, patients were divided randomly into 2 groups. During surgery, the first group were limited to 12 mm Hg intraabdominal pressure (n = 100), and the second group 10 mm Hg intraabdominal pressure (n = 100). The incidence of subcutaneous emphysema in each group and the relationship between subcutaneous emphysema and operation time, table tilt angle, patient age, body mass index (BMI) and end-tidal CO2 (ETco2) were analyzed. The occurrence of subcutaneous emphysema was significantly lower in the group 2 than in group 1 (p = .02). The BMI was significantly lower (p = .02), and peak ETco2 significantly higher (p < .001) in the group in which subcutaneous emphysema developed. However, there were no significant differences in age, operative time, table tilt angle, number of ports used, and initial ETco2 between the groups with and without subcutaneous emphysema.ConclusionsThe incidence of subcutaneous emphysema increased with higher intraabdominal pressure during gynecology laparoscopy. Low BMI and increased intraoperative ETco2 concentration were also related to the occurrence of subcutaneous emphysema.