From the Guidelines
Carbon dioxide is the preferred gas for insufflation in laparoscopic surgery due to its high solubility in blood, which reduces the risk of gas embolism, as encouraged by recent clinical practice updates 1.
Key Benefits of Carbon Dioxide
- High solubility in blood, allowing for rapid absorption and elimination through respiration if it enters the bloodstream, thus reducing the risk of gas embolism.
- Suppresses combustion, making it safer when electrosurgical instruments are used, as it prevents fires or explosions.
- Relatively inexpensive, readily available, and colorless, which maintains clear visibility during the procedure.
Considerations for Use
During laparoscopic procedures, surgeons insufflate the abdominal cavity with carbon dioxide gas to create pneumoperitoneum, which lifts the abdominal wall away from internal organs and provides visibility and room for surgical instruments.
Pressure and Delivery
Typically, carbon dioxide is delivered at a pressure of 12-15 mmHg through a specialized insufflator that monitors and maintains appropriate intra-abdominal pressure throughout the surgery.
Safety and Precautions
While carbon dioxide is generally safe, surgeons must be aware that its absorption can cause respiratory acidosis in some patients, particularly those with compromised pulmonary function.
Recent Guidelines
Recent guidelines also suggest a tailored approach to laparoscopic surgery, considering factors such as surgeon expertise, patient- and disease-related factors, and the availability of appropriate personal protective equipment (PPE) and operating room (OR) equipment to minimize the potential risk of transmission, especially in the context of the COVID-19 pandemic 1.
From the Research
Reasons for Using Carbon Dioxide in Laparoscopic Surgery
- Carbon dioxide is the most frequently used gas for insufflation of the abdominal cavity (pneumoperitoneum) during laparoscopic surgery 2, 3, 4.
- It meets most of the requirements for pneumoperitoneum, although its absorption may be associated with adverse events such as hypercapnia and acidosis 2, 5.
- The use of other gases like helium, argon, nitrogen, nitrous oxide, and room air has been explored as alternatives to carbon dioxide, but their safety and efficacy are still uncertain 2, 3, 4, 5, 6.
Comparison with Other Gases
- Helium has been proposed as a promising alternative to carbon dioxide, as it does not produce respiratory acidosis and is non-toxic, non-flammable, and non-explosive 5, 6.
- Nitrous oxide pneumoperitoneum may decrease post-operative pain in patients with low anaesthetic risk, but its safety and efficacy are still uncertain 3, 4.
- Room air pneumoperitoneum may decrease hospital costs and reduce pain during the first postoperative day, but its safety and efficacy are still uncertain 2, 4.
Potential Risks and Complications
- The absorption of carbon dioxide may be associated with adverse events such as hypercapnia, acidosis, and cardiopulmonary complications 2, 5.
- Helium pneumoperitoneum may cause subcutaneous emphysema, but its incidence is rare 2, 3, 4.
- The use of other gases may be associated with risks such as embolism, respiratory acidosis, and impaired gas exchange 5, 6.