The extraperitoneal approach and subcutaneous emphysema are associated with greater absorption of carbon dioxide during laparoscopic renal surgery.

Abstract

We investigated the association of carbon dioxide absorption with the approach (transperitoneal versus extraperitoneal) and other factors during laparoscopy. Carbon dioxide elimination during laparoscopic renal surgery was retrospectively calculated in 63 patients. Carbon dioxide elimination increased with time. Multiple factorial analysis revealed that subcutaneous emphysema and the extraperitoneal approach were independently associated with a greater increase in carbon dioxide elimination. Pneumothorax and pneumomediastinum were more common during extraperitoneal procedures. Carbon dioxide absorption during laparoscopic renal surgery increases with time, and is greatest in patients treated through an extraperitoneal approach and in those with subcutaneous emphysema. Nonetheless, with attentive ventilatory management adverse sequelae of hypercapnia can be avoided.