LAPAROSCOPIC CHOLECYSTECTOMY USING ABDOMINAL-WALL RETRACTION - HEMODYNAMICS AND GAS-EXCHANGE, A COMPARISON WITH CONVENTIONAL PNEUMOPERITONEUM

Background: Disadvantages related to CO2 pneumoperitoneum have led to development of the abdominal wall retractor (AWR), a device designed t o facilitate laparoscopic surgery without conventional pneumoperitoneu m (15 mmHg CO2). We investigated the effects of the AWR on hemodynamic s and gas exchange in humans. We also investigated whether the use of an AWR imposed extra technical difficulties for the surgeon. A pilot s tudy revealed that cholecystectomy without few-pressure pneumoperitone um was technically impassible. Methods: A prospective randomized contr olled trial: Twenty patients undergoing laparoscopic cholecystectomy w ere randomly allocated into group 1: AWR with low-pressure pneumoperit oneum (5 mmHg), or group 2: conventional pneumoperitoneum (15 mmHg). R esults: Surgery using the AWR lasted longer, 72 +/- 16 min (mean +/- S D) vs 50 +/- 18 min compared with standard laparoscopic cholecystectom y. There were no differences between the groups with respect to hemody namic parameters, although a small reduction of the cardiac output was observed using conventional pneumoperitoneum (from 3.9 +/- 0.7 to 3.2 +/- 1.1 l/min) and an increase during AWR (from 4.2 +/- 0.9 to 5.2 +/ - 1.5 l/min). Peak inspiratory pressures were significantly higher dur ing conventional pneumoperitoneum compared to AWR. A slight decrease i n pH accompanied by an increase in CO2 developed during pneumoperitone um and during the use of the AWR. In both groups arterial PO2 decrease d. Conclusions: The results indicate that the view was impaired during use of the AWR and therefore its use was difficult and time-consuming . Possible advantages of this devices' effects on hemodynamics and ven tilatory parameters could not be confirmed in this study.