Pathophysiologic features of a pneumoperitoneum at laparoscopy: a swine model.
OBJECTIVE
The aim of this study was to examine local and systemic reactions of the body to a pneumoperitoneum to elucidate potential dangers and risks of laparoscopic procedures.


METHODS
Laparoscopy was performed on 25 pigs. The pigs were divided into five groups by level of intraabdominal pressure (14 and 18 mm Hg) and gas used (carbon dioxide and air). The effects of the pneumoperitoneum on cardiopulmonary condition and the peritoneal milieu were observed. These effects should be the result of various changes as the mechanical, ventilatory, cellular, hormonal, and immunologic levels.


RESULTS
In this animal study marked changes in the peritoneal milieu were observed, and we demonstrated that these changes were dependent on the gas used, intraabdominal pressure, and duration of application. Locally these changes are manifest in the development of severe peritoneal acidosis, hypercapnia, and the release of various mediators. Systemic changes, in particular cardiopulmonary changes, also depend on the intraabdominal pressure and the gas used.


CONCLUSIONS
During conventional pneumoperitoneum the peritoneum might change to a large extent so that the development of new risks are possibly encouraged. A reduction in intraabdominal pressure with the use of carbon dioxide as the insufflation gas should result in normal acid-base balance.
Volz
J
J
Department of Gynecology and Obstetrics, Klinikum Mannheim, Faculty of Clinical Medicine, University of Heidelberg, Germany.
Köster
S
S
Weiss
M
M
Schmidt
R
R
Urbaschek
R
R
Melchert
F
F
Albrecht
M
M
D000005:Abdomen; D000138:Acidosis; D000818:Animals; D004195:Disease Models, Animal; D016232:Endothelins / Q000378:metabolism; D006439:Hemodynamics; D010535:Laparoscopy / Q000009:adverse effects; D009638:Norepinephrine / Q000378:metabolism; D010537:Peritoneum / Q000473:pathology; D010587:Phagocytosis; D011027:Pneumoperitoneum / Q000473:pathology / Q000503:physiopathology*; D011312:Pressure; D011669:Pulmonary Wedge Pressure; D012119:Respiration; D013552:Swine
D016232:Endothelins; D009638:Norepinephrine