A COMPARISON OF GASLESS MECHANICAL AND CONVENTIONAL CARBON-DIOXIDE PNEUMOPERITONEUM METHODS FOR LAPAROSCOPIC CHOLECYSTECTOMY

Carbon dioxide (CO2) insufflation with increased intraabdominal pressu re (IAP) has adverse hemodynamic, pulmonary, and renal effects. To avo id these problems, an abdominal wall lift method with a retractor was used to provide the surgical view without CO2 insufflation. Twenty-six patients undergoing elective laparoscopic cholecystectomy were random ly allocated to either the gasless, retractor group, or conventional C O2 pneumoperitoneum group (CPP). Hemodynamic data, ventilatory variabl es, urine output urine oxygen tension, and blood samples for determini ng stress hormones were collected throughout the perioperative period. Patients in the retractor group had lower mean arterial pressure, hea rt rate,and central venous pressure (P < 0.001). They also had higher pulmonary dynamic compliance and needed a lower minute volume of venti lation to achieve normocarbia (P < 0.001). Urine output and oxygen ten sion in urine were higher (P < 0.05) with the retractor method than wi th CPP. Increase in plasma renin activity (P < 0.05) and decrease in c ore temperature (P < 0.001) were smaller with the gasless method than with CPP. The gasless method for laparoscopic cholecystectomy might be beneficial, especially in patients with compromised cardiorespiratory or renal function. Implications: Totally gasless laparoscopic cholecy stectomy was compared with conventional pressure pneumoperitoneum with CO2 insufflation. The gasless method resulted in more stable hemodyna mics and pulmonary function, as well as higher urine, output than conv entional pressure pneumoperitoneum. No changes in renal oxygenation wa s seen with the gasless method, compared with conventional pressure pn eumoperitoneum.