Low-pressure laparoscopy may ameliorate intracranial hypertension and renal hypoperfusion.
BACKGROUND
Increased abdominal pressure is associated with elevations in the intracranial pressure (ICP) and impaired renal function. These adverse effects are potentially important in clinical situations such as severe abdominal trauma and laparoscopic donor nephrectomy. It was hypothesized that the secondary elevation of ICP leads to release of vasoconstrictors, which may affect renal function by decreasing the renal blood flow (RBF). We investigated the effect of laparoscopy on ICP and renal blood flow in a porcine model.


METHODS
The abdominal pressure of swine (N = 5; 20-25 kg) was gradually increased from baseline to 5, 15, and 25 mm Hg by insufflation of nitrogen into the abdominal cavity. The ICP was measured using a Camino monitor, and RBF was simultaneously measured using a Transonic Doppler probe placed on the renal artery. Results were analyzed using repeated measures ANOVA and the paired t-test.


RESULTS
No significant change from baseline was observed in ICP and RBF when the abdominal pressure was 5 mm Hg. However, both ICP and RBF were affected by increasing the abdominal pressure to 15 and 25 mm Hg (P = 0.035 and 0.04 for ICP and P = 0.074 and 0.034 for RBF, respectively).


CONCLUSIONS
Low-pressure laparoscopy may reduce the adverse effects of pneumoperitoneum on ICP and RBF. It may be advisable to use low pressures in laparoscopic surgery, especially when changes in ICP or renal perfusion may have significant clinical implications.
Rosin
Danny
D
Department of Surgery, Cleveland Clinic Florida, Fort Lauderdale, USA. drosin6424@aol.com
Brasesco
Oscar
O
Varela
Javier
J
Saber
Alan A
AA
You
Seong
S
Rosenthal
Raul J
RJ
Cohn
Stephen M
SM
D000704:Analysis of Variance; D000818:Animals; D019586:Intracranial Hypertension / Q000503:physiopathology* / Q000517:prevention & control; D007427:Intracranial Pressure / Q000502:physiology; D010535:Laparoscopy / Q000379:methods*; D009584:Nitrogen / Q000008:administration & dosage; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D012079:Renal Circulation / Q000502:physiology*; D013552:Swine
D009584:Nitrogen