Comparison of Different Carbon Dioxide Insufflation Rates and Intra-Abdominal Pressure in Laparoscopic Hysterectomy

Abstract

Background: Carbon dioxide (CO₂) pneumoperitoneum is essential for laparoscopic hysterectomy but may produce significant hemodynamic alterations depending on the insufflation flow rate and intra-abdominal pressure. Identifying optimal insufflation parameters may improve perioperative safety while maintaining adequate surgical conditions. Aim: To compare the effects of different carbon dioxide insufflation flow rates and intra-abdominal pressures on intraoperative hemodynamic parameters and postoperative outcomes during laparoscopic hysterectomies. Materials and Methods: This prospective randomized controlled trial was conducted among 90 patients undergoing elective laparoscopic surgeries under general anaesthesia. Patients were randomized into three groups according to the carbon dioxide insufflation flow rate: Group A (5 L/min), Group B (8 L/min), and Group C (10 L/min), with pneumoperitoneum maintained at either 10 mmHg or 12 mmHg. Hemodynamic parameters including heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and electrocardiographic changes were recorded at predefined intraoperative intervals. Postoperative pain score, desufflation time, opioid requirement, and recovery parameters were also assessed. Data were analysed using repeated-measures ANOVA, one-way ANOVA, Chi-square test, and Fisher's exact test, with p<0.05 considered statistically significant. Results: Baseline demographic characteristics were comparable among the three groups. Repeated-measures ANOVA demonstrated no significant overall differences in heart rate (p=0.564), systolic blood pressure (p=0.228), diastolic blood pressure (p=0.821), or mean arterial pressure (p=0.882) between the insufflation flow-rate groups. Although mean arterial pressure changed significantly over time (F=3.068, p=0.017), the temporal pattern was similar across all groups. Intra-abdominal pressure demonstrated significant time-dependent interactions for heart rate (p=0.024) and diastolic blood pressure (p=0.044), while overall group differences remained non-significant. Postoperative pain scores (p=0.236), desufflation time (p=0.562), opioid requirement (p=0.056), and perioperative electrocardiographic changes showed no statistically significant differences among the three insufflation flow-rate groups. Conclusion: Carbon dioxide insufflation flow rates of 5, 8, and 10 L/min provide comparable intraoperative hemodynamic stability and postoperative recovery during laparoscopic surgery. Although intra-abdominal pressure influenced the temporal changes in selected hemodynamic variables, varying the insufflation flow rate within the studied range did not significantly affect cardiovascular stability or postoperative outcomes. Lower insufflation flow rates may therefore be considered safe and effective alternatives during elective laparoscopic procedures.