World Journal of Laparoscopic Surgery

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VOLUME 7 , ISSUE 1 ( January-April, 2014 ) > List of Articles


Co2-Pneumoperitoneum in Laparoscopic Surgery: Pathophysiologic Effects and Clinical Significance

Šefik Hasukiæ

Citation Information : Hasukiæ Š. Co2-Pneumoperitoneum in Laparoscopic Surgery: Pathophysiologic Effects and Clinical Significance. World J Lap Surg 2014; 7 (1):33-40.

DOI: 10.5005/jp-journals-10033-1214

Published Online: 01-12-2016

Copyright Statement:  Copyright © 2014; The Author(s).



Knowledge of the pathophysiological basis of laparoscopic procedures, in particular the impact of CO2-pneumoperitoneum (PNP) on the body, can prevent onset of complications during laparoscopy.

Design and Methods

Standard intra-abdominal pressure (IAP), which is used during laparoscopic surgery, is 12 to 15 mm Hg. The direct effect of CO2-pneumoperitoneum is a consequence of the mechanical action of the gas, and increased intra-abdominal pressure. The indirect effect of CO2-pneumoperitoneum caused by the absorption of gas from the abdomen. Analysis of articles that evaluated the effects of CO2-pneumoperitoneum on the body and intra-abdominal organs contributes to an even better use of the laparoscopic method.


The results of numerous experimental and clinical studies have confirmed that increased IAP and CO2-pneumoperitoneum intraoperatively causing reduction the portal venous blood flow, increasing venous stasis, reduced glomerular filtration, reduced Tiffeneau-index and pulmonary compliance what it can lead to hemodynamic and cardiac disorders. Consecutive intraoperative acidosis and hipercarbia impact the function of intra-abdominal organs and heart.


To avoid the side effects of CO2-pneumoperitoneum, which is important in patients with ASA II and more often as necessary to be operate with low pressure (IAP: 6-8 mm Hg) or use gasless laparoscopy.

How to cite this article

Hasukiæ Š. CO2-Pneumoperitoneum in Laparoscopic Surgery: Pathophysiologic Effects and Clinical Significance. World J Lap Surg 2014;7(1):33-40.

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  1. Münch Med Wochenschr 1902;49:21-24.
  2. Laparoscopy the early attempts. Sposrtlighting georg kelling and hans cristian jacobeus. JSLS 1997;1(1):83-85.
  3. Pathophysiology of laparoscopy. Br J Surg 1995;82:1-2.
  4. Physiologic effects of pneumoperitoneum. Am J Surg 1994;167(2):281-286.
  5. Carbon dioxide output in laparoscopic cholecystectomy. Br J Anaesth 1996;76:530-535.
  6. Nitrous oxide pneumoperitoneum revisited. Is there a risk of combustion? Surg Endosc 1995;9(5):501-504.
  7. Helium and other alternative. Surg Endosc 2001;15:553-560.
  8. Helium insufflation in laparoscopic surgery. Endosc Surg Allied Technol 1995;3:183-186.
  9. Hemodynamic effects of argon pneumoperitoneum. Surg Endosc 1994;8: 315-320.
  10. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg 2004;21(2):95-105.
  11. Pulmonary function after laparoscopic and open cholecystectomy. Surgical Endoscopy 2002;16(1):163-165.
  12. Diaphragm function after upper abdominal surgery in humans. Amer Rev Resp Dis 1983;127:431-436.
  13. Postoperative pulmonary changes after laparoscopic cholecystectomy. Medicinski Arhiv 2001;55(2):23-25.
  14. Changes in lung and chest wall properties with abdominal insufflation of carbon dioxide are immediately reversible. Anesth Analg 1996;82:501-505.
  15. Postoperative pulmonary changes after laparoscopic cholecystectomy. Annals of Saudi Medicine 2002;22(3-4):259-261.
  16. Effects of carbon dioxide pneumoperitoneum for laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2000;44:834-841.
  17. Pathophysiologic effects of CO2-pneumoperitoneum in laparoscopic surgery. Acta Med Croatica 2007;61(2):165-170.
  18. Assessment of pulmonary function in patients before and after laparoscopic and open esophagogastric surgery. Surg Endosc 2005;19(1):133-136.
  19. Postoperative pulmonary function in open versus laparoscopic cholecystectomy: a meta-analysis of the Tiffeneau index. Dig Surg 2008;25(1):1-7.
  20. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev 2006.
  21. Randomized clinical trial of the effect of pneumoperitoneum on cardiac function and haemodynamics during laparoscopic cholecystectomy. Br J Surg 2004;91(7):848-854.
  22. Anesthesia for laparoscopy: a review. J Clin Anesth 2006;18(1):67-78.
  23. The relationship among carbbon dioxide pneumoperitoneum, vasopressin release, and hemodynamic chnages. Anesth Analg 1999;89:278-283.
  24. Laparoscopic cholecystectomy-effect of position changes and CO2 pneumoperitoneum on hemodynamic, respiratory and endocrinologic parameters. Zentralbl Chir 1997;122(5):395-404.
  25. Pneumoperitoneum in healthy humans is not associated with increased central blood volume. Acta Anaesthesiol Scand 1999;43:809-814.
  26. Changes in splanchninc blood flow and cardiovascular effects following peritoneal insufflation of carbon dioxide. Surg Endosc 1993;7:420-423.
  27. Splachning ischemia during laparoscopic cholecystectomy. Surg Endosc 1996;10:324-326.
  28. Complications of laparoscopic surgery. Clin Obstet Gynecol 2002;45:469-480.
  29. Cinel I. Does splanchninc ischemia occur during laparoscopic cholecystectomy. Surg Endosc 2002;16(3):468-471.
  30. Mechanism and role of intrinsic regulation of hepatic arterial blood flow: hepatic arterial buffer response. Am J Physiol 1985;249(5 Pt 1):G549-G556.
  31. Effect of insufflation gas and intra-abdominal pressure on portal venous flow during pneumoperitoneum in the rat. Surg Endosc 2001;15:405-408.
  32. Loss of physiologic hepatic blood flow control (hepatic arterial buffer response) during CO2-pneumoperitoneum in the rat. Anesth Analg 2001;93:872-877.
  33. Subclinical hepatic disfunctionin laparoscopic cholecystectomy and laparoscopic colectomy. Br J Anaesth 2001;87(5):774-777.
  34. The European Association for Endoscopic Surgery Clinical Practice Guideline on the Pneumoperitoneum for Laparoscopic Surgery. Surg Endosc 2002;16:1121-1143.
  35. Comparison of postoperative hepatic function between laparoscopic and open cholecystectomy. Medical Principles and Practice 2005;14(3):147-150.
  36. Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc 1998;12:129-133.
  37. Postoperative changes in liver function tests: randomized comparison between low-pressure and high-pressure laparoscopic cholecystectomy. Surgical Endoscopy 2005;19(11):1451-1455.
  38. Are elevated liver enzymes and bilirubin levels significant after laparoscopic cholecystectomy in the absence of bile duct injury? Ann Surg 1994;219(4):362-364.
  39. Alterations in hepatic function during laparoscopic surgery: an experimental clinical study. Surg Endosc 1998;12:968-972.
  40. Changes in liver function tests after laparoscopic cholecystectomy: not so rare, not always ominous. Am Surg 2000;66(7):699-702.
  41. Liver enzyme alterations after laparoscopic cholecystectomy. J Gastrointestin Liver Dis 2007;16(4):391-394.
  42. Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev 2009;2: Art. No: CD006930. DOI: 10.1002/14651858.C D006930.pub2.
  43. Routine testing of liver function before and after elective laparoscopic cholecystectomy: is it necessary? JSLS 2011;15(1):65-69.
  44. Overcoming reduced hepatic and renal perfusion caused by positive-pressure pneumoperitoneum. Arch Surg 2007;142(2):119-124;discussion 125.
  45. Effect of pneumoperitoneum on renal perfusion and function: a systematic review. Surg Endosc 2007;21:152-160.
  46. Measurement of urinary N-acetyl-beta-D-glucosaminidase to assess renal ischemia during laparoscopic operations. Surg Endosc 1999:13;503-506.
  47. Incidence of clinically evident deep venous thrombosis after laparoscopic Roux-en gastric bypass. Surg Endosc 2004;18:1082-1084.
  48. lu M, Aydin Y, Sa.lam M. Lower extremity venous changes in pneumoperitoneum during laparoscopic surgery. ANZ J Surg 2006;76(10):904-906.
  49. Duplex ultrasound assessment of femoral venous flow during laparoscopic and open gastric bypass. Surg Endosc 2003;17(2):285-290.
  50. S, Nuhbegovic. S, Ljuca F, Hasukic. S, Petrov- Rasljic. J, Jovic. S. D-dimer as a parameter of hypercoagulability in laparoscopic cholecystectomy. Acta Medica Saliniana 2009;38(2):81-85.
  51. Laparoscopic procedures as a risk factor of deep venous thrombosis, superficial ascending thrombophlebitis and pulmonary embolism-case report and review of the literature. Eur J Med Res 2004 Sep 29;9(9):417-422.
  52. Intermittent sequential pneumatic compression in prevention of venous stasis associated with pneumoperitoneum during laparoscopic cholecystectomy. Arch Surg 1993;128(8):914-908;discussion 918-919.
  53. Intermittent sequential compression of the lower limbs prevents venous stasis in laparoscopic and convetional colorectal surgery. Dis Colon Rectum 1997;40:1056-1062.
  54. Diagnostic laparoscopy increases intracranial pressure. J Trauma 1994;36:815-819.
  55. Changes in cerebral hemodynamics during laparoscopic cholecystectomy. Neurol Res 1999;21(7):658-660.
  56. The dangers of diagnostic laparoscopy in the head injured patient. J Clin Neurosci 2002;9(5):592-593.
  57. Pathophysiology of pneumoperitoneum. In: Hasukiæ,et al, editors. Principles of laparoscopic surgery. Suton. Široki Brijeg 2008;85-96.
  58. Intermittent pneumatic sequential comparison of the lower extremities restores the cerebral oxygen saturation during laparoscopic cholecystectomy. Surg Endosc 2008;22(4):907-911.
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