Early Cardiopulmonary Changes of Retro- and Intraperitoneal Insufflation in Urologic Laparoscopic Surgery

Kim, Dong Woo; Chung, Seok Hyun; Kang, Kyung Joong; Ryu, Dong Soo; Oh, Tae Hee; Kim, Young Jae

Abstract

PURPOSE: Laparoscopic techniques are being increasingly used for retroperitoneal surgery. However, there have been few studies regarding the physiological alterations of retroperitoneal carbon dioxide (CO2) insufflation in humans. The physiological effects were compared between retroperitoneal and intraperitoneal insufflation.
MATERIALS AND METHODS
Data on 66 patients who underwent laparoscopic renal (55), adrenal (10) or ureteral (1) surgery, via retroperitoneal (45) or intraperitoneal (21) approaches between July 1999 and January 2003, were collected retrospectively. The hemodynamic changes were assessed and arterial blood gas analysesis taken during an hour of insufflation, and analyzed for statistical differences.
RESULTS
During the hour of CO2 insufflation, the hemodynamic parameters (heart rate, systolic blood pressure, and central venous pressure) and results of the arterial blood gas analyses (pH, PaCO2 and PaO2) indicated no significant differences between the retroperitoneal and intraperitoneal groups. The central venous pressure continued to increase in both the retroperitoneal (p=0.003) and intraperitoneal groups (p=0.005), with a similar magnitude. The increase in PaCO2 (p<0.001) and the decrease in arterial pH (p<0.001) after CO2 insufflation were significant in the retroperitoneal group.
CONCLUSIONS
The physiological changes during urologic laparoscopic surgery are the same, regardless of the insufflation routes during an hour of insufflation, while the respiratory effects are relatively more pronounced with retroperitoneal insufflation. Therefore, intraperitoneal as well as retroperitoneal laparoscopic surgeries might be a safe treatment modality during an hour of insufflation when careful monitored and correction performed.