RANDOMIZED COMPARISON OF THE NEUROENDOCRINE RESPONSE TO LAPAROSCOPIC CHOLECYSTECTOMY USING EITHER CONVENTIONAL OR ABDOMINAL-WALL LIFT TECHNIQUES

Increases in plasma renin activity and noradrenaline concentration occ ur in response to carbon dioxide insufflation during laparoscopic chol ecystectomy. In a randomized study the conventional carbon dioxide pne umoperitoneum was compared with the abdominal wall lift method for lap aroscopic cholecystectomy, with special reference to neuroendocrine ch anges and renal function. The total mean(s.d.) volume of carbon dioxid e insufflated was 42(23) litres with the conventional methods and 9(7) litres with abdominal wall lift (P <0.001). Mean(s.d.) intra-abdomina l pressure after 15 min of insufflation was 11(2) and 3(9) mmHg respec tively (P <0.01). In the conventional group mean(s.d) plasma rein acti vity increased slightly from 5.5(2.1) to 6.1(2.0) ng ml(-1) during the first 55 min of laparoscopic cholecystectomy. In the abdominal wall l ift group plasma renin activity decreased from 5.3(2.7) to 3.8(0.9) ng ml(-1) (P <0.01) between the groups). Plasma antidiuretic hormone con centration increased similarly in both groups. Diuresis was significan tly less with conventional pneumoperitoneum during the first 35 min of the operation compared with the abdominal wall lift method (p <0.001) . There were significant increased in plasma noradrenaline concentrati on in both groups (P <0.001), but the increase was slightly higher in the conventional group during th first 15 min of insufflation. The abd ominal wall lift method with minimal carbon dioxide insufflation was a ssociated with smaller neuroendocrine responses and better preservatio n or renal function compared with conventional carbon dioxide pneumope ritoneum.