J Endourol. 2022 Sep 15. doi: 10.1089/end.2022.0233. Online ahead of print.
ABSTRACT
OBJECTIVE: To evaluate the effects of CO2 pneumoperitoneum on venous hemodynamics and cardiopulmonary function during transperitoneal or retroperitoneal laparoscopic surgery.
METHODS: A single institution prospective study. 43 patients with renal cell carcinoma undergoing retroperitoneal (22) or transperitoneal (21) laparoscopic partial nephrectomy were enrolled. Hemodynamic functions were monitored by Swan-Ganz and radial artery catheters. Transesophageal echocardiography was used to measure the diameter and blood flow of the inferior vena cava (IVC). Measured parameters were recorded at baseline, 10 min, 30 min, 60 min following insufflation to 14 mmHg and 10 min following desufflation.
RESULTS: For hemodynamic changes in transperitoneal laparoscopic group (TPL) and retroperitoneal laparoscopic group (RPL), transperitoneal CO2 insufflation resulted in a rapid parallel increase in central intravenous pressure (CVP), peak airway pressure (AWP) and IVC blood flow velocity after the first 30 minutes of pneumoperitoneum (p＜0.05). In contrast, CVP, AWP and IVC blood flow velocity increased progressively in RPL. The variation of those parameters was significantly lower than that of TRL (p＜0.001；p=0.002；p=0.004). The mean maximum CVP in the two groups was 20 and 16 mmHg, respectively. The IVC diameter at the cavoatrial junction was significantly reduced in TPL after 10 minutes of insufflation, but it remained unchanged in RPL throughout the surgery. For cardiopulmonary function changes, heart output decreased after a short period of pneumoperitoneum, but no statistical differences were observed between the two groups. The increments of partial pressure of arterial carbon dioxide and end-tidal carbon dioxide tension were significantly higher in RPL than TPL (p＜0.001; p＜0.001).
CONCLUSIONS: Compared with retroperitoneal pneumoperitoneum, transperitoneal pneumoperitoneum has significantly effects on IVC hemodynamics. Elevated intraabdominal pressure (IAP) causes higher AWP and venous return resistance, which lead to the significantly increase of CVP during transperitoneal approach. Adjusting the balance between IAP and CVP might be an effect way to control intravenous bleeding.
PMID:36106602 | DOI:10.1089/end.2022.0233
