LAPAROSCOPY WITHOUT PNEUMOPERITONEUM - EFFECTS OF ABDOMINAL-WALL RETRACTION VERSUS CARBON-DIOXIDE INSUFFLATION ON HEMODYNAMICS AND GAS-EXCHANGE IN PIGS

Laparoscopic surgery with CO2 insufflation is associated with adverse effects on hemodynamics and gas exchange. The abdominal wall retractor (AWR) is an alternative for pneumoperitoneum. Hemodynamics and gas ex change during the use of an AWR were compared to those of CO2 pneumope ritoneum. In eight pigs subjected to 1 h of CO2 pneumoperitoneum or ab dominal wall retraction, hemodynamics, gas exchange, and oxygen transp ort were studied in a randomized cross-over study design. The only cha nge observed during abdominal wall retraction was mild respiratory alk alosis. In contrast, during CO2 pneumoperitoneum mean arterial blood p ressure increased 13%, central filling pressures doubled, and a small increase in cardiac output was observed. Peak airway pressures increas ed 50%, endtidal CO2 increased 20%, and respiratory acidosis was induc ed (arterial pH from 7.46 +/- 0.07 to 7.31 +/- 0.06 and pCO(2) from 33 +/- 3 mmHg to 53 +/- 4 mmHg). Arterial PO2 decreased but mixed venous oxygen saturation and oxygen consumption were unaffected. In contrast with CO2 pneumoperitoneum, laparoscopy using abdominal wall retractio n was not associated with adverse effects on hemodynamics or gas excha nge.