Correlation between CO2 storage at the last minute of gas insufflation and area of retroperitoneal lacuna during retroperitoneal laparoscopic radical nephrectomy

Abstract

BackgroundAdequate operation interspace is the premise of laparoscopy, and carbon dioxide (CO2) was an ideal gas for forming lacuna. A retroperitoneal space is used to form operation interspace in retroperitoneal laparoscopic radical nephrectomy by making ballooning, and the retroperitoneal space has no relative complete and airtight serous membrane, therefore CO2 absorption may be greater in retroperitoneal than transperitoneal laparoscopic radical nephrectomy. Excess CO2 absorption may induce hypercapnemia and further cause physiopathological change of respiratory and circulatory system. Therefore, exact evaluation of amount of CO2 which is eliminated from body via minute ventilation is important during retroperitoneal laparoscopic radical nephrectomy. The aim of the paper is to study the correlation between CO2 storage at the last minute of gas insufflation and area of retroperitoneal lacuna during retroperitoneal laparoscopic radical nephrectomy.MethodsForty ASA I/II patients undergoing retroperitoneal laparoscopic radical nephrectomy were enrolled. CO2 storage at the last minute of gas insufflation and area of a retroperitoneal lacuna were observed. Linear correlation and regression were performed to determine the correlation between them.ResultsThere was positive correlation between CO2 storage at the last minute of gas insufflation and area of retroperitoneal lacuna (r = 0.880, P = 0.000), and the equation of linear regression was y = −83.097 + 0.925x (R2 = 0.780, t = 11.610, P = 0.000).ConclusionsAmount of CO2 which is eliminated from body via mechanical ventilation could be calculated by measuring the area of retroperitoneal lacuna during retroperitoneal laparoscopic radical nephrectomy, and an anesthetist should be aware of the size of lacuna to predict high CO2 storage at the last minute of gas insufflation.

To describe minimally invasive esophagectomy with a focus on peri-esophageal lacuna anatomy

“…For clearer exposure of PEL tissues such as the nourishing arteries, nerves and lymph nodes, an arti cial pneumothorax was used to expand the PEL facilitating radical resection and improving surgical safety [12,[24][25][26]. This is consistent with the role of an arti cial pneumoperitoneum in surgeries involving the liver, stomach, intestine and kidney [8,12,13,27]. Finally, we designed a sequence for dissection of different parts of the PEL.…”

“…In the left lateral position with the bed inclined forward 30 degrees, we had good surgical vision and avoided this esophageal sheltering [20][21][22][23]. For clearer exposure of PEL tissues such as the nourishing arteries, nerves and lymph nodes, an arti cial pneumothorax was used to expand the PEL facilitating radical resection and improving surgical safety [12,[24][25][26]. This is consistent with the role of an arti cial pneumoperitoneum in surgeries involving the liver, stomach, intestine and kidney [8,12,13,27].…”

“…Lacuna anatomy has been studied in various human organs and tissues including the cerebral ventricles [3], pericardium [4], articular cavity [5], carpal tunnel [6], tarsal tunnel [7], liver [8], nasolacrimal duct [9], esophageal submucosa [10,11] and retroperitoneal lacunae [12][13][14]. These studies were closely related to the operative approach and surgical procedure.…”