Hemodynamics during laparoscopic extra- and intraperitoneal insufflation. An experimental study.
BACKGROUND
Total extraperitoneal laparoscopic surgery is an alternative to the laparoscopic transperitoneal route; however, its effects on hemodynamics have not been adequately studied. This experimental study compared the effects of intraperitoneal insufflation and extraperitoneal insufflation on hemodynamics and oxygen transport.


METHODS
Sixteen pigs were randomly assigned for intraperitoneal insufflation or extraperitoneal insufflation with 15 mmHg carbon dioxide. Hemodynamic and oxygen transport parameters were taken during an hour of insufflation and analyzed for statistical differences.


RESULTS
During extraperitoneal CO2 pneumoperitoneum central venous filling pressures (central venous pressure, pulmonary capillary wedge pressure and mean pulmonary arterial pressure) and end-tidal CO2 increased slower but to a similar magnitude in comparison to intraperitoneal insufflation. Cardiac output and indices of oxygen consumption and oxygen delivery were equally affected by both types of insufflation. Arterial CO2 pressure increased significantly more during intraperitoneal insufflation.


CONCLUSIONS
The data from this study suggest that extraperitoneal insufflation might result in less cardiovascular impairment than intraperitoneal insufflation.
Bannenberg
J J
JJ
Department of Surgery, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands.
Rademaker
B M
BM
Froeling
F M
FM
Meijer
D W
DW
D000704:Analysis of Variance; D000818:Animals; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000008:administration & dosage; D004195:Disease Models, Animal; D006439:Hemodynamics / Q000502:physiology*; D010535:Laparoscopy / Q000379:methods*; D010101:Oxygen Consumption; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011312:Pressure; D011897:Random Allocation; D013552:Swine
D002245:Carbon Dioxide