Key Physiological Considerations in Laparoscopic Insufflation

  • Published: 5/19/2025
  • 3 min
Laparoscopic surgery typically requires CO₂ insufflation at 12–15 mmHg, but increasing evidence suggests that lower intra-abdominal pressure may help mitigate physiological stress while maintaining adequate surgical exposure.

Studies highlight several pressure-related physiological effects, including:

Respiratory effects such as increased peak airway pressure and elevated end-tidal CO₂2, 8, 15
Cardiovascular alterations, including changes in mean arterial pressure and venous return3, 5, 7
Postoperative discomfort that may contribute to prolonged recovery times4, 9, 19

Clinical studies suggest that operating at lower pressures may help reduce these effects, particularly in high-risk patients and complex procedures.

Examining the Evidence

A review of 40 peer-reviewed studies covering over 11,000 patients indicates that low-pressure insufflation may contribute to:

Stable respiratory and hemodynamic metrics, including reductions in MAP, end-tidal CO₂, and peak airway pressure2, 8, 14

Fewer complications, including decreased instances of subcutaneous emphysema and postoperative ileus4, 11, 12

These findings apply across various surgical specialties, including urology, gynecology, colorectal surgery, and general surgery.6, 7, 33

Alignment with ENHANCED RECOVERY AFTER SURGERY (ERAS)

ERAS protocols aim to reduce postoperative complications and support faster recovery. Low-pressure insufflation aligns with these strategies by reducing physiological stress and improving patient comfort.5, 9, 20

A pooled analysis of 3,000 patients across 20 studies found that low-pressure laparoscopy was associated with shorter PACU stays and reduced hospitalization time—metrics that are important for both patient recovery and healthcare efficiency.4, 5, 9

Learn more about ERAS

Considerations for Healthcare Systems

Beyond clinical outcomes, lower insufflation pressures may support hospital efficiency, as studies suggest:

Reduced operative time and fewer complications4, 12, 39

Shorter lengths of stay, potentially contributing to lower resource utilization1, 7, 23

An evaluation of U.S. hospital cost data found that lower-pressure insufflation systems may reduce hospital stays by up to 50% and PACU time by 33%, particularly in procedures such as robotic-assisted prostatectomy and colorectal surgery.1, 7, 23

As research continues to evolve, low-pressure insufflation is gaining recognition as a potential strategy to enhance recovery after surgery (ERAS) and reduce physiological impact. Its adoption may require coordination among surgeons, anesthesiologists, and perioperative teams, but studies suggest that it aligns with patient-centered surgical care approaches.

Whether incorporated into routine laparoscopic procedures or used within ERAS programs, understanding the role of insufflation pressure may help guide future advancements in minimally invasive surgery.

References:

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