Influence of pneumoperitoneum pressure on surgical field during robotic and laparoscopic surgery: a comparative study

Purpose Studies on the influence of CO 2 pneumoperitoneum on the abdominal cavity during robotic procedures are lacking. This is the first study to evaluate surgical field modifications related to CO 2 pressure, during laparoscopic and robotic surgery. Methods Consecutive patients scheduled for laparoscopic or robotic hysterectomy were enrolled in the study. To evaluate the level of operative field visualization, a dedicated form has been designed based on the evaluation of four different areas: Douglas space, vesico-uterine fold and, bilaterally, the broad ligament. During the initial inspection, an assistant randomly set the CO 2 pressure at 15, 10 and 5 mmHg, and the surgeon, not aware of the CO 2 values, was asked to give an evaluation of the four areas for each set pressure. Results In laparoscopic group, CO 2 pressure significantly influenced the surgical field visualization in all four areas analyzed. The surgeon had a good visualization only at 15 mmHg CO 2 pressure; visualization decreased with a statistically significant difference from 15 to 5, 15–10 and 10–5 mmHg. In robotic group, influence of CO 2 pressure on surgical areas visualization was not straightforward; operative field visualization remained stable at any pressure value with no significant difference. Conclusions Pneumoperitoneum pressure significantly affects the visualization of the abdomino-pelvic cavity in laparoscopic procedures. Otherwise, CO 2 pressure does not affect the visualization of surgical field during robotic surgery. These findings are particularly significant especially at low CO 2 pressure with potential implications on peritoneal environment and the subsequent post-operative patient recovery.