HEMODYNAMIC-EFFECTS OF MECHANICAL PERITONEAL RETRACTION DURING LAPAROSCOPIC CHOLECYSTECTOMY

Purpose: Abdominal wall retraction (AWR) was recently proposed as an a lternative for CO2 pneumopentoneum. In this study we evaluated the car diorespiratory effects of AWR during laparoscopic cholecystectomy. Met hods: Fifteen patients were studied during laparoscopic cholecystectom y using AWR. Monitoring included heart rate (HR), mean arterial pressu re (MAP), pulse oxymetry (SpO(2)), end-tidal CO2 (PETCO2), minute vent ilation, and peak inspiratory pressure (PIP). Using transoesophageal e chocardiography, the transgastric short axis view was obtained to deri ve the end-diastolic area (EDA), the end-systolic area (ESA), and the ejection fraction (EF). These parameters were measured at predetermine d periods: I) live minutes after anaesthetic induction, 2) five minute s after AWR insertion, 3) 15 min after AWR insertion, and 4) after the end of surgery. Results: No change in any measured parameter was obse rved over time in the AWR group except for an increase in MAP (P<0.05) after AWR insertion. There were no changes in EDA, ESA and EF during the study, reflecting stable global cardiac function. In addition, no embolic episodes were observed during surgery. Conclusion: Our results demonstrate that the use of gasless abdominal distention for laparosc opic cholecystectomy results in a stable haemodynamic profile in healt hy patients without cardiac disease, except for a brief increase in MA P after the AWR insertion. The advantages of AWR over conventional pne umoperitoneum should be confirmed in higher risk patients in a prospec tive, randomized study.