Surgical Endoscopy

, Volume 27, Issue 9, pp 3465–3473

Carbon dioxide gas pneumoperitoneum induces minimal microcirculatory changes in neonates during laparoscopic pyloromyotomy

  • Stefaan H. A. J. Tytgat
  • David C. van der Zee
  • Can Ince
  • Dan M. J. Milstein
Dynamic Manuscript

Abstract

Background

Little is known about the direct effect of pneumoperitoneum (PP) on microcirculation and its influence on the quality of tissue perfusion. This study aimed to investigate the intraoperative effects of carbon dioxide (CO2) gas PP on microcirculation density and perfusion in neonates receiving laparoscopic surgery for hypertrophic pyloric stenosis.

Methods

In a single-center observational study, the oral microcirculation in 12 neonates receiving laparoscopic pyloromyotomy was investigated. Intraoperative hemodynamic parameters, intermittent buccal mucosa capillary density measurements (pre- and postoperative), and continuous intraoperative sublingual microcirculation measurements (i.e., vessels with a diameter <25 μm) of total vessel density, perfused vessel density, proportion of perfused blood vessels, blood vessel diameters (BVd), and microvascular flow index were obtained before (at baseline), during, and after PP insufflation for all patients using sidestream dark-field imaging for the duration of the complete surgical procedure.

Results

With the exception of a significantly elevated end-tidal CO2 (34 ± 4–40 ± 8 mmHg; p < 0.05 vs before [baseline], one-way analysis of variance [ANOVA]) during intraoperative insufflation, no significant differences were found between time points for the intraoperative hemodynamic parameters. Pre- and postoperative buccal capillary density showed no significant changes in mucosal perfusion. Analysis of continuous intraoperative sublingual microcirculation parameters exhibited a statistically significant increase in BVd during insufflation (8.8 ± 2.4–9.3 ± 2.5 μm; p < 0.05, one-way ANOVA) and a significant decrease after exsufflation (8.2 ± 2.3 μm; p < 0.01 vs during insufflation and p < 0.05 vs baseline, one-way ANOVA, respectively). No other significant differences were found between time points for the remaining microcirculatory parameters.

Conclusion

The installation of CO2 gas PP during laparoscopic pyloromyotomy procedures regulates microcirculatory perfusion by inducing changes in microvascular diameters but does not alter microcirculation density in neonates.

Keywords

Laparoscopy Microcirculation Neonate Pneumoperitoneum SDF imaging 

Supplementary material

Supplementary material 1 (MOV 14149 kb)

Supplementary material 2 (MOV 109903 kb)

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Stefaan H. A. J. Tytgat
    • 1
  • David C. van der Zee
    • 1
  • Can Ince
    • 2
  • Dan M. J. Milstein
    • 2
    • 3
  1. 1.Department of Pediatric SurgeryWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Department of Translational PhysiologyAcademic Medical Center, University of AmsterdamAmsterdamThe Netherlands
  3. 3.Department of Oral and Maxillofacial SurgeryAcademic Medical Center, University of AmsterdamAmsterdamThe Netherlands

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