Hemodynamic changes during gaseous and gasless laparoscopic cholecystectomy.
OBJECTIVE
The main disadvantage of gaseous laparoscopic surgery is the need for CO(2) insufflation and the elevation of intra-abdominal pressure. Gasless laparoscopic surgery is an alternative to gaseous laparoscopic surgery, which avoids the hazardous effects of pneumoperitoneum. This study was conducted to investigate the hemodynamic effects of pneumoperitoneum and to compare gasless and gaseous laparoscopic cholecystectomy on a hemodynamic basis.


METHODS
The gasless laparoscopic procedure uses an electromechanical retractor system to lift the abdominal wall. We performed 20 gaseous and 11 gasless laparoscopic cholecystectomies in a collective total of 31 patients with symptomatic gallstones. The mean arterial pressure, heart rate, end diastolic index, systemic vascular resistance index, cardiac index (CI), ejection fraction (EF), and stroke index (SI) values were monitored noninvasively by thoracic electrical bioimpedance.


RESULTS
In the gaseous group, statistically significant changes were detected in CI, EF, and SI values after insufflation as compared to the values before pneumoperitoneum. In the gasless group, only minimal changes were detected in the SI values, which were not significant.


CONCLUSIONS
Gasless laparoscopy has little effect on the hemodynamic parameters of patients and provides an alternative to the gaseous technique in selected cases.
Sixth Department of Surgery, Ankara Numune Training and Research Hospital, Samanpazari, Turkey.
Atila
A
Korkmaz
Muhittin
M
Alkiş
Okan
O
Hamamci
Hasan
H
Besim
Nilüfer
N
Erverdi
D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D011028:Pneumoperitoneum, Artificial; D011446:Prospective Studies