Under a low pressure with high flow setting, which finding best explains the loss of working space?

• A. There is a leak in the insufflation circuit
• B. Check that the tubing has not become disconnected from insufflator or port
• C. Check that all valves are closed
• D. Check all port sites for leaking CO2

Answer: (A)

Maintaining a stable pneumoperitoneum depends on a closed, intact insufflation circuit. When you set a low pressure but use a high flow, any breach in that circuit lets CO2 escape, so the intraabdominal pressure cannot be sustained and the working space collapses. A leak in the insufflation circuit is the most direct explanation because it covers any breach that causes gas to escape and prevents maintaining the target pressure.

A disconnected tubing is a specific instance of a circuit leak, so it would also cause this problem, but the underlying issue is the circuit leak itself. A valve being closed would stop gas flow rather than create a loss of space while gas is flowing. CO2 leaking at port sites likewise causes loss, but the fundamental mechanism remains the leak in the circuit keeping the pressure from being maintained.