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INTRODUCTION: Diagnostic laparoscopy has recently emerged as an alternative to laparotomy in trauma patients. However, the impact of abdominal insufflation on intracranial pressure is not well described outside animal models. We present a retrospective review of patients who underwent a laparoscopic assisted ventriculoperitoneal shunt placement (lap VPS) at our single institution with intraoperative intracranial pressure (ICP) measurements.
METHODS: Retrospective chart review was performed for sequential patients who underwent laparoscopic-assisted VPS placement since 2008. Abdominal insufflation was performed using CO2 to 15mmHg. ICP was measured through the ventricular catheter with insufflation and desufflation, using a manometer. Baseline data were obtained as well including: age, sex, HTN, CHF, cancer, cirrhosis, renal failure, BMI, and prior abdominal or cranial surgery. Paired t-tests were performed to determine differences between ICP on insufflation and desufflation. Baseline data analyzed using linear regression to the ICP difference.
RESULTS: Nine patients had ICP measurements noted. The mean increase in ICP with insufflation was 7.22 cm H2O (95%CI:5.38-9.07; p<0.001). The maximum ICP difference was 12.5cm H2O. The maximum ICP measured in this population with insufflation was 25 cm H2O. None of the baseline data measured had a significant effect on increase in ICP with insufflation.
DISCUSSION: ICP was significantly elevated with the insufflation associated with laparoscopy up to a maximum 12.5 cm H2O above the desufflated baseline. These data suggest that laparoscopy should be used cautiously in patients with a baseline elevated ICP or head trauma.