Chronic effect of pneumoperitoneum on renal histology.
OBJECTIVE
Transient intraoperative oliguria is a constant phenomenon during laparoscopic procedures. Laboratory studies have demonstrated that this effect is secondary to a decrease in renal blood flow caused by the pneumoperitoneum. With the advent of laparoscopic harvest of the kidney for renal transplantation, a concern is that increased intra-abdominal pressure may compound the effect of acute cold and warm renal ischemia during transplantation. Acute transient renal ischemia can produce chronic sclerosing histopathologic changes in native kidneys which are similar to those seen in chronic allograft rejection. The effect of positive-pressure abdominal pneumoperitoneum (15 mm Hg) on native kidneys was examined using a rodent model. The effects on renal function and histologic features were also studied.


METHODS
Twenty-four Harlan Wistar-Furth rats were divided into four groups: controls, 1-hour pneumoperitoneum-91-day survival, 5-hour pneumoperitoneum-91-day survival, and 5-hour pneumoperitoneum-7-day survival. Control animals underwent placement of the Veress needle and anesthesia but no induction of pneumoperitoneum. At the time of sacrifice, blood was sampled for serum creatinine measurement. Both kidneys were harvested for frozen and permanent section and stained using hematoxylin and eosin. Specimens were graded for inflammatory and ischemic/sclerotic changes in the interstitium, tubules, glomeruli, and vasculature by a renal pathologist using a histologic score (0-3).


RESULTS
In all groups, at a sacrifice interval of either 1 week or 3 months, there were no statistical differences in the histologic score, serum creatinine concentration, or renal weight.


CONCLUSIONS
In a rodent model, no signs of chronic ischemic histologic changes were detected for a period of 3 months after up to 5 hours of pneumoperitoneum. As well, there was no change in the serum creatinine concentration.
Department of Urology, James Buchanan Brady Urological Institute, Baltimore, Maryland, USA.
B R
BR
Lee
J A
JA
Cadeddu
G
G
Molnar-Nadasdy
D
D
Enriquez
T
T
Nadasdy
L R
LR
Kavoussi
L E
LE
Ratner
D000818:Animals; D003404:Creatinine / Q000097:blood; D004195:Disease Models, Animal; D005500:Follow-Up Studies; D007511:Ischemia / Q000097:blood / Q000209:etiology / Q000473:pathology; D007668:Kidney / Q000098:blood supply / Q000473:pathology*; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D009929:Organ Size; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects* / Q000401:mortality; D011312:Pressure; D051381:Rats; D011920:Rats, Inbred WF; D015996:Survival Rate
D003404:Creatinine