• C S Ng, I S Gill, G T Sung, D G Whalley, R Graham, and D Schweizer.
• Section of Laparoscopic and Minimally Invasive Surgery, Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA.
• J. Urol. 1999 Oct 1; 162 (4): 1268-72.

PurposePrevious studies have suggested that retroperitoneal laparoscopy is associated with greater carbon dioxide absorption and related postoperative morbidity, such as subcutaneous emphysema and pneumothorax. We prospectively compared the effects of carbon dioxide absorption during transperitoneal and retroperitoneal laparoscopic renal and adrenal surgery at our institution.Materials And MethodsData were collected prospectively on 51 patients who underwent laparoscopic renal (26) or adrenal (25) surgery via the transperitoneal (18) or retroperitoneal (33) approach from September 1997 to February 1998.ResultsThere was no significant difference in carbon dioxide elimination in patients who underwent transperitoneal laparoscopy compared to retroperitoneoscopy at any interval. Subcutaneous emphysema occurred in 12.5% of the transperitoneal and 45% of the retroperitoneal group (p = 0.09). Patients with subcutaneous emphysema had greater carbon dioxide elimination during the first 2.5 hours of insufflation compared to those without subcutaneous emphysema and, thereafter, carbon dioxide elimination decreased to baseline.ConclusionsIn contrast to previous reports our prospective nonrandomized study suggests that retroperitoneoscopy is not associated with greater carbon dioxide absorption compared to transperitoneal laparoscopy. Patients with subcutaneous emphysema exhibited only transient increases in carbon dioxide absorption above control levels.

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