Cystosufflation to prevent bladder injury

This brief report will share information about the use and safety of inflating the bladder with carbon dioxide to delineate the margins during laparoscopic dissections near the bladder in patients who have scarring, adhesions, or challenging anatomy.

A retrospective chart review of patients undergoing total or radical laparoscopic hysterectomy, or support procedures from September 5, 1996, through October 30, 2008, was conducted. Canadian Task Force level III.

Community hospital.

Of 1004 patients having simple or radical laparoscopic hysterectomy or laparoscopic support procedures, cystosufflation was used in 173 patients. Indications included finding of adhesions from earlier cesarean section or massive myomas obscuring bladder margins, or planned anterior colpopexy or vaginal sacrocolpopexy.

Cystosufflation uniformly entailed the following: clamping of the bladder catheter with a Kelly clamp; connection of the laparoscopic carbon-dioxide insufflation tubing to the catheter; then under direct laparoscopic observation, release of the Kelly clamp with immediate bladder inflation revealing the cystic margins.

Cystosufflation safely facilitated the dissection of the bladder off the anterior cervix and vagina, or off the anterior abdominal wall. Distention of the bladder elevated and rounded up the bladder margins so that the muscularis could be clearly identified, preventing bladder injury in all patients. No urologic complications occurred in these cases.

These retrospective data suggest that cystosufflation is well tolerated by patients and can reliably prevent cystotomy.