Advertisement

Urological Research

, Volume 24, Issue 6, pp 361–366 | Cite as

Changes in urinary output and electrolytes during gaseous and gasless laparoscopy

  • A. W. Chiu
  • L. S. Chang
  • D. H. Birkett
  • R. K. Babayan
Original Paper

Abstract

Urological laparoscopy has gained increasing acceptance recently. Alterations in renal water and electrolyte homeostasis by carbon dioxide peritoneal insufflation, retroperitoneal insufflation and abdominal wall lifting were measured in 30 well-hydrated pigs over a 2-h period. Oliguria was observed after gaseous insufflation but not after lifting the abdominal wall. Return to normal urinary output was observed at 30 min after release of pneumoretroperitoneum, and 60 min after pneumoperitoneum. Creatinine clearance declined, while the clearance rates of potassium, sodium and urea remained unchanged during peritoneal and retroperitoneal insufflation. An elevated serum aldosterone concentration was found which may mediate the increased urinary excretion of potassium and decreased urinary excretion of sodium found during peritoneal insufflation. Renal function remained stable, despite an elevation of serum creatine kinase being elicited after lifting the abdominal wall. In conclusion, significant changes in water and electrolyte homeostasis occurred during gaseous, not gasless, laparoscopy in pigs.

Key words

Hormone Electrolyte Renal function Laparoscopy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Carey RM, Sen S (1986) Recent progress in the control of aldosterone secretion. Recent Prog Horm Res 42:251PubMedGoogle Scholar
  2. 2.
    Chang DT, Kirsch AJ, Sawczuk IS (1994) Oliguria during laparoscopic surgery. J Endourol 8:349PubMedGoogle Scholar
  3. 3.
    Chiu AW, Azadzoi KM, Hatzichristou DG, Siroky MB, Krane RJ, Babayan RK (1994) Effect of intra-abdominal pressure on renal tissue perfusion during laparoscopy. J Endourol 8:99PubMedGoogle Scholar
  4. 4.
    Diebel LN, Wilson RF, Dulchavsky SA, Saxe J (1992) Effects of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma 33: 279PubMedGoogle Scholar
  5. 5.
    Doyle DJ, Mark PW (1989) Laparoscopy and vagal arrest. Anesthesia 44:448Google Scholar
  6. 6.
    Gaur DD, Agarwal DK, Purohit KC (1993) Retroperitoneal laparoscopic nephrectomy: initial case report. J Urol 149:103PubMedGoogle Scholar
  7. 7.
    Harman PK, Kron IL, McLachlan HD, Freedlender AE, Nolan SP (1982) Elevated intra-abdominal pressure and renal function. Ann Surg 196:594PubMedGoogle Scholar
  8. 8.
    Ichikawa I, Brener BM (1984) Glomerular actions of angiotensin II. Am J Med 76:43CrossRefPubMedGoogle Scholar
  9. 9.
    Kashtan J, Green JF, Parson EQ, Holcroft JW (1981) Hemodynamic effects of increased abdominal pressure. J Surg Res 30:249CrossRefPubMedGoogle Scholar
  10. 10.
    Kavoussi LR, Kerbl K, Capelouto CC, McDougall EM, Clayman RV (1993) Laparoscopic nephrectomy for renal neoplasms. Urology 42:603CrossRefPubMedGoogle Scholar
  11. 11.
    Kavoussi LR, Sosa RE, Chandhoke PJ (1993) Complications of laparoscopic lymph node dissection. J Urol 149:322PubMedGoogle Scholar
  12. 12.
    Levens NR, Peach MJ, Vaughan ED Jr, Carey RM (1981) Demonstration of a primary anti-diuretic action of angiotensin II: effects of intrarenal converting enzymes inhibition in the conscious dog. Endocrinology 108:318PubMedGoogle Scholar
  13. 13.
    Mullet CE, Viale JP, Sagnard PE, Miellet CC, Ruynay LG, Counioux HC, Motin JP, Boulex JP, Dargent DM, Annat GJ (1993) Pulmonary CO2 elimination during surgical procedures using intra- or extraperitoneal CO2 insufflation. Anesth Analg 76:622PubMedGoogle Scholar
  14. 14.
    Pate JW, Estes JW (1968) Effects of elevated venous pressure on kidney function. Am Surg 34:729PubMedGoogle Scholar
  15. 15.
    Phillips J, Keith D, Hulka J, Hulka B, Keith L (1975) Gynecologic laparoscopy in 1975. J Reprod Med 16:105Google Scholar
  16. 16.
    Roith DL, Bark H, Nyska M, Glick, SM (1982) The effect of abdominal pressure on plasma antidiuretic hormone levels in the dog. J Surg Res 32:65CrossRefPubMedGoogle Scholar
  17. 17.
    Schirmer HKA, Marshall RE, Jackson MP (1968) The effect of altered renal venous pressure on urine flow and cortical metabolism. J Urol 100:205PubMedGoogle Scholar
  18. 18.
    Schrier RW, Lieberman R, Ufferman RC (1977) Mechanisms of antidiuretic effect of beta adrenergic stimulation. J Clin Invest 51:97Google Scholar
  19. 19.
    Shenasky JH, Gillenwater JY (1972) The renal hemodynamic and functional effects of external counterpressure. Surg Gynecol Obst 134:253Google Scholar
  20. 20.
    Sosa RE, Weingram J, Poppas D, Lyons J (1992) Physiological consideration in laparoscopic surgery in urology. J Endourol 6:85Google Scholar
  21. 21.
    Wolf JS, Stoller ML (1994) The physiology of laparoscopy: basic principles, complications and other considerations. J Urol 152:294PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • A. W. Chiu
    • 1
  • L. S. Chang
    • 1
  • D. H. Birkett
    • 2
  • R. K. Babayan
    • 3
  1. 1.Division of Urology, Department of SurgeryNational Yang-Ming University, School of Medicine, Veterans General Hospital-TaipeiTaipeiTaiwan, Republic of China
  2. 2.Department of General SurgeryLahey Hitchcock Medical CenterBurlingtonUSA
  3. 3.Department of UrologyBoston University School of MedicineBostonUSA

Personalised recommendations