Y. Ogihara et al., Abdominal wall lift versus carbon dioxide insufflation for laparoscopic resection of ovarian tumors, J CLIN ANES, 11(5), 1999, pp. 406-412
Study Objective: To evaluate and compare changes in pulmonary mechanics and
stress hormone responses between abdominal wall lift (gasless) and carbon
dioxide (CO2) insufflation laparoscopic surgery during controlled general a
nesthesia.
Design: Prospective randomized clinical study.
Setting: Operating roms at a university medical center.
Patients: 12 ASA physical status I and II female patients undergoing laparo
scopic resection of ovarian tumors. Interventions: Patients were divided in
to two groups of six each. the abdominal wall lift group and the CO, pneumo
peritoneum laparoscopic group. Following induction of anesthesia, patients
were paralyzed and the trachea was intubated. Anesthesia was maintained wit
h isoflurane and nitrous oxide (N2O) in oxygen. Throughout the procedure, p
atients were mechanically ventilated with a tidal volume of 10 ml/kg and a
respiratory rate of 10 breaths per minute.
Measurements and Main Results: During the laparoscopic procedure, arterial
blood gases, acid-base balance, pulmonary mechanics, stress-related hormone
s, and urine output were measured and recorded. In the CO2 pneumoperitoneum
group, arterial CO, tension increased (p <0.01), dynamic pulmonary complia
nce decreased (p < 0.01), peak inspiratory airway pressure increased (p <0.
01), and plasma epinephrine (p < 0.05), norepinephrine (p < 0.05), dopamine
(p < 0.01) and antidiuretic hormones (p < 0.05) increased significantly du
ring the laparoscopic procedure as compared to the abdominal lift group. Ad
renocorticotropic hormone anti cortisol increased ns compared to baseline v
alue in both groups (p < 0.05). Urine output was significantly less (p < 0.
01) in the CO2 pneumoperitoneum group than in the abdominal wall lift group
.
Conclusions: Abdominal wall lift laparoscopic surgery is physiologically su
perior to CO2 pneumoperitoneum laparoscopic surgery as seen during the cond
itions of this study. Abdominal wall lift laparoscopic surgery provides nor
mal acid-base balance and a lesser degree of hormonal stress responses, it
maintains urine output, and it avoids derangement of pulmonary mechanics. (
C) 1999 by Elsevier Science Inc.