Physiologic Changes during Laparoscopic Surgery for Upper Urinary Tract

Kim, Hyeon Hoe; Park, Kwanjin; Hong, Sung Kyu; Lee, Kook Hyun; Choi, Hwang; Kim, Si Whang

Abstract

PURPOSE: Presently laparoscopic urologic surgical procedures are being performed with increasing frequency. Despite the evolution of laparoscopic technique and instruments, the large set of physiologic alteration associated with laparoscopy are poorly understood. We have recently performed prospective study to evaluate the physiologic effects of pneumoperitoneum created during laparoscopic surgery.
MATERIALS AND METHODS
Seventeen consecutive patients with various upper urinary tract diseases underwent laparoscopic surgeries at our institution. They were checked pre and postoperatively for such parameters as blood pressure, heart rate, arterial blood gas analysis(ABGA), end tidal CO2(ETCO2), peak airway pressure, temperature. Every patient was classified as ASA class 1 or 2 preoperatively. All insufflrated pressure was adjusted not to go over 14mmHg. All patients were positioned laterally for easier access to retroperitoneum. We evaluated the differences of various physiologic indices with statistical means.
RESULTS
After 2hr insufflation, a marked hypercarbia and acidemia was observed intraoperatively suggesting that capnography may be an inadequate guide in controlling ventilation during the state of CO2 pneumoperitoneum in the upper urinary tract laparoscopic surgery. Eight patients suffered perioperative hypothermia(below 35.5degrees C). In the four of eight patients prolonged stay in recovery room were necessary due to their hypothermia.
CONCLUSIONS
Because the upper urinary tract laparoscopic surgery causes many physiologic changes, surgeons should be aware of its meanings and clinical implications prior to achieving technical skillfulness in laparoscopic surgery.