Haemodynamic effects of mechanical peritoneal retraction during laparoscopic cholecystectomy

Abstract

Reports of Investigation Haemodynamic effects of mechanical peritoneal retraction during laparoscopic cholecystectomyPurpose: Abdominal wall retraction (AWR) was recently proposed as an alternative for CO 2 pneumoperitoneum, In this study we evaluated the cardiorespiratory effects of AWR during laparoscopic cholecystectomy, Methods: Fifteen patients were studied during laparoscopic cholecystectomy using AWR. Monitoring included heart rate (HR), mean arterial pressure (MAP), pulse oxymetry (SpO2), end-tidal CO 2 (PETCO2), minute ventilation, and peak inspiratory pressure (PIP). Using transoesophageal echocardiography, the transgastric short axis view was obtained to derive the end-diastolic area (EDA), the end-systolic area (ESA), and the ejection fraction (EF). These parameters were measured at predetermined periods: I) five minutes after anaesthetic induction, 2) five minutes after AVVR insertion, 3) 15 rnin after AWR insertion, and 4) after the end of surgery. Results: No change in an), measured parameter was observed over time in the AWR group except for an increase in IVlAP (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 laparoscopic cholecystectomy results in a stable haemodynamic profile in healthy patients without cardiac disease, except for a brief increase in MAP after the AWR insertion. The advantages of AWR over conventional pneumoperitoneum should be confirmed in higher risk patients in a prospective, randomized study.

Effects of carbon dioxide pneumoperitoneum for laparoscopic cholecystectomy

“…Recently a number of abdominal wall lift (AWL) methods have been developed and used for surgical laparoscopy because adverse effects of CO 2 and elevated IAP are also well recognized by the surgeons. Some of these devices are used in combination with low pressure pneumoperitoneum ( 11) and some completely without any gas insufflation ( 12, 54, 55, 85, 86). The advantages of these systems are the lack of haemodynamic stress response, no occurrence of disturbances in acid‐base balance, better restored renal function and adequate splanchnic circulation ( 12, 54, 55, 85, 86).…”

“…Some of these devices are used in combination with low pressure pneumoperitoneum ( 11) and some completely without any gas insufflation ( 12, 54, 55, 85, 86). The advantages of these systems are the lack of haemodynamic stress response, no occurrence of disturbances in acid‐base balance, better restored renal function and adequate splanchnic circulation ( 12, 54, 55, 85, 86). Unfortunately, the surgical view is not always optimal; especially exposure to lateral spaces is limited.…”

“…Recently a number of abdominal wall lift (AWL) methods have been developed and used for surgical laparoscopy because adverse effects of CO 2 and elevated IAP are also well recognized by the surgeons. Some of these devices are used in combination with low pressure pneumoperitoneum (11) and some completely without any gas insufflation (12,54,55,85,86).…”

“…The advantages of these systems are the lack of haemodynamic stress response, no occurrence of disturbances in acid-base balance, better restored renal function and adequate splanchnic circulation (12,54,55,85,86). Unfortunately, the surgical view is not always optimal; especially exposure to lateral spaces is limited.…”