title: Microdialysis monitoring for evaluation of the influence exerted by pneumoperitoneum on the kidney: an experimental study.
abstract: BACKGROUND
  Laparoscopic donor nephrectomy has become the first choice for living donor kidney transplantation, offering advantages over open donor nephrectomy. This study aimed to evaluate kidney tissue metabolism during and after pneumoperitoneum using a microdialysis technique.
  
  
  METHODS
  Eight pigs underwent laparotomy and implantation of two microdialysis catheters: one in the cortex and one in the medulla of the left kidney. After laparotomy, the abdominal wall was closed, and pneumoperitoneum was induced with a constant standard pressure of 16 to 18 mmHg for 4 h, followed by rapid desufflation. In microdialysis samples collected from intrarenal catheters, markers of ischemia (glucose, lactate, pyruvate, and lactate-pyruvate ratio) and the marker of cell membrane injury (glycerol) were monitored.
  
  
  RESULTS
  There were no changes in glucose, lactate, or pyruvate level before, during, or after pneumoperitoneum, either in the cortex or in the medulla. Additionally, the calculated lactate-pyruvate ratio did not show signs of ischemia during or after pneumoperitoneum. However, with regard to the marker of cell injury, glycerol increased in the medulla after decompression from 22.57 +/- 3.76 to 35.67 +/- 5.43 mmol/l (p < 0.01). This release of glycerol in the medulla was significantly higher than in the cortex (area under the curve [AUC], 22.18 +/- 4.87 vs 34.79 +/- 7.88 mmol/l; p < 0.01).
  
  
  CONCLUSIONS
  The pattern of metabolic changes monitored in the kidney during and after pneumoperitoneum indicates some kind of cell injury predominant in the medulla without any signs of kidney ischemia. This nonischemic injury could be related to hyperperfusion of the kidney after decompression or injury to cells attributable to mechanical cell expansion at the point of rapid decompression.
authors: Department for Clinical Science, Intervention and Technology (CLINTEC), Division of Transplantation Surgery, Karolinska Institute, Karolinska University Hospital, Huddinge, B56 141-86, Stockholm, Sweden. Takashi.Iwata@ki.se
authors: T
authors: T
authors: Iwata
authors: A
authors: A
authors: Gilispie
authors: C
authors: C
authors: Jorns
authors: S
authors: S
authors: Yamamoto
authors: G
authors: G
authors: Nowak
authors: B-G
authors: BG
authors: Ericzon
mesh_terms: D000818:Animals; D019540:Area Under Curve; D005947:Glucose / Q000378:metabolism; D005990:Glycerol / Q000378:metabolism; D007668:Kidney / Q000378:metabolism*; D019344:Lactic Acid / Q000378:metabolism; D010535:Laparoscopy; D017551:Microdialysis; D009392:Nephrectomy / Q000379:methods*; D011028:Pneumoperitoneum, Artificial; D019289:Pyruvic Acid / Q000378:metabolism; D018709:Statistics, Nonparametric; D013552:Swine
chemical_list: D019344:Lactic Acid; D019289:Pyruvic Acid; D005947:Glucose; D005990:Glycerol
references: Surg Endosc. 2003 Jan;17(1):108-10
references: 12239648
references: Liver Transpl. 2002 May;8(5):424-32
references: 12004341
references: Surg Gynecol Obstet. 1976 Apr;142(4):593-606
references: 816021
references: J Neurol Neurosurg Psychiatry. 1998 Apr;64(4):486-91
references: 9576540
references: Transplant Proc. 1997 Dec;29(8):3402-3
references: 9414765
references: J Surg Res. 2006 Sep;135(1):2-8
references: 16564544
references: Transplantation. 2000 Jun 15;69(11):2319-23
references: 10868632
references: J Intern Med. 1991 Oct;230(4):381-6
references: 1919434
references: Transplantation. 1992 Mar;53(3):540-5
references: 1549844
references: Transplantation. 1999 Mar 15;67(5):722-8
references: 10096529
references: J Neurochem. 1966 Nov;13(11):1057-67
references: 5924657
references: Transplantation. 2000 Jun 15;69(11):2277-81
references: 10868626
references: Am J Transplant. 2005 Apr;5(4 Pt 1):739-45
references: 15760397
references: J Hepatobiliary Pancreat Surg. 2001;8(2):161-8
references: 11455474
references: Ann Surg. 1997 Oct;226(4):483-9; discussion 489-90
references: 9351716
references: Eur J Clin Invest. 1999 Nov;29(11):947-52
references: 10583439
references: Transplantation. 1995 Nov 15;60(9):1047-9
references: 7491680
references: Diabetologia. 1992 Dec;35(12):1177-80
references: 1478372
references: Surg Endosc. 1998 Feb;12 (2):129-32
references: 9479726