Microdialysis monitoring for evaluation of the influence exerted by pneumoperitoneum on the kidney: an experimental study.
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.
Iwata
T
T
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
Gilispie
A
A
Jorns
C
C
Yamamoto
S
S
Nowak
G
G
Ericzon
B-G
BG
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
D019344:Lactic Acid; D019289:Pyruvic Acid; D005947:Glucose; D005990:Glycerol
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