Effect of Pneumoperitoneum on Renal Tissue Oxygenation and Blood Flow in a Rat Model

Wiesenthal, Joshua D.; Fazio, Luke M.; Perks, Alexandra E.; Blew, Brian; Mazer, C. David; Hare, Greg; Honey, R. John D'a.; Pace, Kenneth T.

doi:10.1016/j.urology.2011.02.022

Cited by 39 publications

(40 citation statements)

References 20 publications

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“…Both groups subjected to PP exhibited oliguria, an effect repeatedly reported in previous studies [4][5][6][7][8][9][10][11]16 . No difference was observed regardless of whether CO 2 or helium was used for insufflation.…”

Section: Discussionsupporting

confidence: 73%

“…Laparoscopic access, in turn, is associated with decreased pain, lower morbidity, superior cosmesis, shorter postoperative stay and return to preoperative activities as compared with open techniques [2][3][4][5] . Carbon dioxide (CO 2 ) is the gas employed most widely for insufflation, given that it is noncombustible, relatively inexpensive and highly soluble in blood, minimizing the risk of embolism [2][3]6 .…”

Section: Introductionmentioning

confidence: 99%

“…Carbon dioxide (CO 2 ) is the gas employed most widely for insufflation, given that it is noncombustible, relatively inexpensive and highly soluble in blood, minimizing the risk of embolism [2][3]6 . However, PP increases intra-abdominal pressure, which has been shown to produce oliguria and renal dysfunction in both animal and clinical studies [1][2][4][5][6][7][8][9][10][11][12] . In healthy young patients, these changes tend to be mild and reversible due to the various physiologic mechanisms for CO 2 buffering and elimination 2,12 .…”

Section: Introductionmentioning

confidence: 99%

“…These adverse effects are also relevant in laparoscopic nephrectomies for live donor transplantation, due to concerns regarding possible PP-related graft damage 1,4-5,13-14 . Despite extensive research in the last two decades, the exact mechanisms responsible for the renal effects of PP have not been entirely elucidated 5,12 . Vascular and parenchymal compression certainly plays a role, though hormonal factors 1-2,5-7,10-11 and, more recently, oxidative stress 4,9,13 have been suggested as well.…”

Section: Introductionmentioning

confidence: 99%

“…They include persistence of renal changes for some hours after desufflation [1][2]5,[8][9][10][11] , increased renin activity in dogs following CO 2 (but not helium) insufflation 10 and higher vasopressin levels 7,10 , as well as complete oliguria, reversed with N-acetylcysteine 9 or a vasopressin receptor antagonist 7 . Histopathological changes have also been assessed, although they are reported only occasionally in the literature 2,4,11,[13][14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

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Effects of pneumoperitoneum with carbon dioxide and helium on renal function and morphology in rats

Freitas¹,

Durães²,

Carvalho³

et al. 2013

Acta Cir. Bras.

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PURPOSE:To evaluate the effects of pneumoperitoneum with carbon dioxide and helium on renal function and morphology in a rat model. METHODS:Twenty four rats were randomized into three groups (n=8): gasless insufflation ('open', Pressure=0 mmHg), carbon dioxide pneumoperitoneum at 12 mmHg, and helium pneumoperitoneum at 12 mmHg; all lasting 90 minutes.. A cystostomy was performed and the bladder was emptied. At the end of the experiment, the urine produced, a blood sample and the left kidney of each animal were collected. The following variables were obtained: serum sodium, potassium, urea and creatinine, urine volume and creatinine. The creatinine clearance was estimated for each animal. The kidneys were stained with hematoxylin and eosin (HE) and evaluated by a pathologist blinded to the groups. RESULTS:The CO 2 and Helium groups did not differ in the variables evaluated. Both developed oliguria (p<0.001 vs. gasless). The CO 2 group presented hyperkalemia compared to gasless (p=0.05), which did not attain significance in the helium group. Histopathological analysis revealed mild hydropic degeneration and congestion in the three groups, with no significant difference among them. CONCLUSIONS:The type of gas resulted in no difference in the variables of renal function and morphology assessed. The increase in serum potassium was only observed with CO 2 insufflation suggests a combined effect of elevated intra-abdominal pressure and metabolic effects of pneumoperitoneum.

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