Backfilling the Bladder With CO2: An Alternative to Traditional Methods of Delineating the Bladder

INTRODUCTION: Backfilling the bladder with fluid during gynecologic surgery is a common practice to delineate bladder borders and to minimize or identify bladder injury. However, backfilling with fluid can be time consuming, taking approximately 1 minute for a 150-mL backfill, and requires additional equipment. Alternatively, it takes only seconds to backfill with CO2 instead by connecting the insufflation tubing to the Foley catheter tubing and expanding the bladder to the desired amount under direct visualization. In our academic minimally invasive gynecologic surgery (MIGS) division, we routinely backfill with carbon dioxide (CO2) instead of fluid during laparoscopy. OBJECTIVE: The purpose of this video is to illustrate an alternative method of backfilling the bladder to identify bladder boundaries during laparoscopic surgery. METHODS: The video provides stepwise instructions of how to backfill the bladder with CO2 during multiple surgical scenarios using narrated video footage. We illustrate the utility of backfilling with CO2 through surgical videos of an excision of endometriosis, a hysterectomy, and an evaluation of suprapubic port placement. RESULTS: N/A. CONCLUSIONS: Backfilling the bladder with CO2 during laparoscopy is an efficient method for delineating bladder borders and is safe to use when performed under direct visualization. There remain times when backfilling with fluid such as methylene blue may be appropriate. CO2 insufflation is an effective tool to have in your skillset for bladder evaluation.