THE IMPACT OF PNEUMOPERITONEUM, PNEUMORETROPERITONEUM, AND GASLESS LAPAROSCOPY ON THE SYSTEMIC AND RENAL HEMODYNAMICS

BACKGROUND: The use of therapeutic laparoscopy has become widespread r ecently, It is important to assess the effects of gaseous and gasless laparoscopy on systemic and renal hemodynamics. STUDY DESIGN: A prospe ctive controlled animal study was performed on 40 well-hydrated pigs. Systemic and renal hemodynamics were monitored during peritoneal insuf flation, retroperitoneal insufflation, and abdominal wall lifting for a period of two hours. A laser Doppler flow meter was applied laparosc opically to measure the renal cortical tissue perfusion. RESULTS: Peri toneal insufflation of carbon dioxide to a pressure of 15 mm Hg elicit ed transient elevations of the aortic pressure and carotid arterial bl ood flow Unilateral pneumoretroperitoneum caused a smaller change on s ystemic hemodynamics. Pneumoperitoneum and pneumoretroperitoneum cause d oliguria. Superficial renal cortical blood flow reduction decreased by an average of 60 percent in the compressed kidney, and blood flow r eturned to the pre-insufflation level after the pressure was released, A gradual decrease of tissue perfusion in the contralateral kidney an d a concomitant gradual increase of the intraabdominal pressure were o bserved when pneumoretroperitoneum was maintained for two hours. No si gnificant changes in urinary output and in systemic and renal hemodyna mics were found when the abdominal wall was lifted up with a force equ ivalent to 15 mm Hg. CONCLUSIONS: Significant systemic and renal hemod ynamic changes were elicited in gaseous but not in gasless laparoscopy , which may explain the decreased urinary output observed during gaseo us laparoscopy, Pneumoperitoneum caused greater systemic and renal hem odynamic alterations than pneumoretroperitoneum; however, the effects were transient and reversible after a period of two hours.