• S Schulze, K M Lyng, K Bugge, A Perner, A Bendtsen, J Thorup, H J Nielsen, V Rasmussen, and J Rosenberg.
• Department of Surgery, Sundby Hospital, Copenhagen, Denmark. svsc@glostruphosp.kbhamt.dk
• Arch Surg Chicago. 1999 Oct 1; 134 (10): 1112-8.

HypothesisGasless laparoscopy produces smaller cardiopulmonary and systemic changes than carbon dioxide (CO2) laparoscopy during colonic surgery.DesignProspective randomized trial.SettingDepartment of Surgery in a university hospital.PatientsTwenty-two patients scheduled for laparoscopic colonic resection; 5 patients were excluded because of conversion to open surgery (N = 17).InterventionsPatients were randomized to either gasless (n = 9) or conventional CO2 (n = 8) surgery.Main Outcome MeasuresIntraoperative assessment of hemodynamic factors and pulmonary function, and postoperative assessment of pain, pulmonary function, convalescence, and various injury factors were done several times until 30 days after surgery. Surgical complications were noted.ResultsDescending aorta blood flow after 30 minutes (P=.03) and heart rate after 150 minutes were higher in the CO2 group (P=.009). Central venous pressure, PaCO2 inspiration pressure, and end tidal CO2 level were significantly higher in the CO2 group (P = .05, .03, .04, and .01, respectively). Patients in the CO2 group had less pain during mobilization and coughing (P = .008 and .006, respectively), and were significantly more fatigued (P = .04). No other important differences were observed in intraoperative hemodynamic factors, postoperative convalescence, immunocompetence, or pulmonary function.ConclusionNo clinically important differences in cardiovascular and systemic response were observed between patients undergoing CO2 or gasless laparoscopy for colonic disease.

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