Ventilatory and hemodynamic changes during retroperitoneal and transperitoneal laparoscopic nephrectomy: a prospective real-time comparison.
OBJECTIVE
Nephrectomies are currently performed via the transperitoneal or retroperitoneal laparoscopic approach. We compared the ventilatory and hemodynamic effects of these approaches.


METHODS
After institutional ethics committee approval was obtained patients requiring nephrectomy in a 9-month period were prospectively allocated to the retroperitoneal (24) or transperitoneal (15) approach. All were initially ventilated in the volume controlled mode (10 ml kg tidal volume). Intraoperative fingertip, pulse derived arterial oxygen saturation less than 97%, end tidal CO2 partial pressure greater than 40 mm Hg and peak inspiratory pressure greater than 36 cm H2O necessitated changes in ventilatory parameters, as deemed necessary by the anesthetist. If tidal volume decreased greater than 25% of baseline, pressure controlled ventilation was begun instead.


RESULTS
Peak inspiratory and plateau pressures increased for the transperitoneal approach by approximately 30% more than in the retroperitoneal group (p <0.05). Volume controlled ventilation was changed to pressure controlled ventilation in 8 transperitoneal vs zero retroperitoneal cases (p <0.05). Heart rate, and systolic and diastolic blood pressure increased by approximately 13% more in the transperitoneal than in the retroperitoneal group (p <0.05).


CONCLUSIONS
Nephrectomy via the retroperitoneal laparoscopic approach interferes with ventilatory and hemodynamic functions less than nephrectomy via the transperitoneal approach.
Nadu
Andrei
A
Department of Urology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ekstein
Perla
P
Szold
Amir
A
Friedman
Alan
A
Nakache
Richard
R
Cohen
Yitzhak
Y
Matzkin
Haim
H
Weinbroum
Avi A
AA
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood; D003199:Computer Systems; D003625:Data Collection; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007320:Inspiratory Capacity / Q000502:physiology*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008432:Mathematical Computing; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009392:Nephrectomy / Q000379:methods*; D010100:Oxygen / Q000097:blood; D010529:Peritoneal Cavity; D011446:Prospective Studies; D012121:Respiration, Artificial; D012187:Retroperitoneal Space; D012984:Software; D013990:Tidal Volume / Q000502:physiology*
D002245:Carbon Dioxide; D010100:Oxygen