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

Study Objective: To estimate the effect of intraabdominal pressure and risk factors related to the occurrence of subcutaneous emphysema during laparoscopic surgery. Design: Prospective randomized study (Canadian Task Force classification I). Setting: University hospital. Patients: Two hundred patients who underwent gynecologic laparoscopy because of benign gynecologic disease or cervical intraepithelial neoplasia. Interventions: Gynecologic laparoscopy. Measurements and Main Results: Before 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 CO ₂ (ETco ₂) 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 ETco ₂ 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 ETco ₂ between the groups with and without subcutaneous emphysema. Conclusions: The incidence of subcutaneous emphysema increased with higher intraabdominal pressure during gynecology laparoscopy. Low BMI and increased intraoperative ETco ₂ concentration were also related to the occurrence of subcutaneous emphysema.