J. Volz et al., PATHOPHYSIOLOGIC FEATURES OF A PNEUMOPERITONEUM AT LAPAROSCOPY - A SWINE MODEL, American journal of obstetrics and gynecology, 174(1), 1996, pp. 132-140
OBJECTIVE: The aim of this study was to examine local and systemic rea
ctions of the body to a pneumoperitoneum to elucidate potential danger
s and risks of laparoscopic procedures. STUDY DESIGN: Laparoscopy was
performed on 25 pigs. The pigs were divided into five groups by level
of intraabdominal pressure (14 and 18 mm Hg) and gas used (carbon dixo
ide and air). The effects of the pneumoperitoneum on cardiopulmonary c
ondition and the peritoneal milieu were observed. These effects should
be the result of various changes at the mechanical, ventilatory, cell
ular, hormonal, and immunologic levels. RESULTS: In this animal study
marked changes in the peritoneal milieu were observed, and we demonstr
ated that these changes were dependent on the gas used, intraabdominal
pressure, and duration of application. Locally these changes are mani
fest in the development of severe peritoneal acidosis, hypercapnia, an
d the release of various mediators. Systemic changes, in particular ca
rdiopulmonary changes, also depend on the intraabdominal pressure and
the gas used. CONCLUSION: During conventional pneumoperitoneum the per
itoneum might change to a large extent so that the development of new
risks are possibly encouraged. A reduction in intraabdominal pressure
with the use of carbon dioxide as the insufflation gas should result i
n normal acid-base balance.