Pulmonary function alteration in laparoscopic surgery with pneumoperitoneum and abdominal wall elevation

Technical challenges of lymphadenectomy in renal carcinoma performed with a 3D laparoscopic approach at a low pressure pneumoperitoneum due to associated pulmonary pathology – case report

“…Habitual volume of pneumoperitoneum may induce hypercapnia and acidosis due to rapid CO 2 absorption into the blood circulation, also lung atelectasis which will prompt peri operative pulmonary dysfunction (mechanical stress) due to the cyclic recruitment of atelectasis areas [5,7]. Due to effective monitoring of pulmonary ventilation during surgery, the patients present manageable risks of pulmonary events due to pneumoperitoneum, with conversion being performed in due time if imposed.…”

“…When pulmonary pathology is added (e.g. chronic obstructive pulmonary disease COPD), a lower pressure is imposed to avoid conversion to open surgery if pulmonary ventilation is endangered [4,5,6]. The lower intra-abdominal pressure requires adaptations of the surgical management, since the operative field is reduced, with less control of possible hemorrhagic events [7].…”