Efficiency and Diagnostic Utility of CO₂ Cystoscopy After Laparoscopic Gynecologic Surgery

This study aimed to compare the efficiency and diagnostic performance of carbon dioxide (CO₂) versus saline as a distension medium during routine cystoscopy performed after laparoscopic gynecologic surgery.

We conducted a prospective, comparative study involving patients undergoing total laparoscopic hysterectomy for benign indications. Participants were randomly assigned to undergo diagnostic cystoscopy using either CO₂ or saline for bladder distension. Primary outcomes included total cystoscopy duration and time to visualize bilateral ureteral jets. Secondary outcomes were intraoperative detection rates of lower urinary tract injuries and any postoperative urinary complications.

A total of 529 patients were included (CO₂ group: 270; 51.1%; saline group: 259; 48.9%). Cystoscopy duration was significantly shorter in the CO₂ group compared to the saline group (150 vs 120 seconds; P < .001). Time to visualize ureteral jets was also reduced in the CO₂ group (43 seconds; P < .001). One bladder injury and 1 ureteral obstruction were identified intraoperatively and successfully repaired in the same surgical session. The use of CO₂ eliminated the need for diuretics or chromatic dyes, streamlining the diagnostic process and potentially reducing costs.

CO₂ cystoscopy is a safe, efficient, and diagnostically effective alternative to conventional saline cystoscopy following gynecologic laparoscopy. Its use significantly reduces procedural time without compromising the detection of urinary tract injuries and avoids the need for additional agents such as dyes or diuretics. These findings support the integration of CO₂ cystoscopy into routine intraoperative surveillance protocols during minimally invasive gynecologic surgery.