Increased carbon dioxide absorption during retroperitoneal laparoscopy.

Abstract

Retroperitoneoscopy for renal surgery is now a common procedure. We compared carbon dioxide absorption in patients undergoing retroperitoneoscopy for adrenal or renal surgery with that of patients undergoing laparoscopic cholecystectomy. We measured carbon dioxide elimination with a metabolic monitor in 30 anaesthetized patients with controlled ventilation, undergoing retroperitoneoscopy (n=10), laparoscopy (n=10) or orthopaedic surgery (n=10). Carbon dioxide production increased by 38, 46 and 63% at 30, 60 and 90 min after insufflation (P<0.01) in patients having retroperitoneoscopy. Carbon dioxide production (mean (SD)) increased from 92 (21) to 150 (43) ml x min(-1) m(-2) 60-90 min after insufflation and remained increased after the end of insufflation. During laparoscopy, V(.)(CO(2)) increased less (by 15%) (P<0.05 compared with retroperitoneoscopy) and remained steady throughout the procedure. Retroperitoneal carbon dioxide insufflation causes more carbon dioxide absorption than intraperitoneal insufflation, and controlled ventilation should be increased if hypercapnia should be avoided.