Abstract
Background
Extraperitoneal laparoscopic prostatectomy is an alternative to the intraperitoneal method. However, the effects of extraperitoneal carbon dioxide (CO2) insufflation on hemodynamics and respiratory data have not been adequately studied. This study compared the effects of prolonged intra- and extraperitoneal CO2 insufflation on hemodynamics and gas exchange.
Methods
For this study, 20 patients were assigned to receive totally endoscopic robot-assisted radical prostatectomy (TERP) via the intra- or extraperitoneal approach. Hemodynamic parameters and respiratory data were obtained during 8 h of insufflation and analyzed for statistical differences.
Results
With both insufflation methods, arterial CO2 pressure increased rapidly, reaching higher levels with extraperitoneal insufflation. Therefore, patients managed with extraperitoneal insufflation required a significantly higher minute ventilation. Heart rate and central venous pressure increased in both groups, whereas mean arterial blood pressure and pH decreased.
Conclusions
Prolonged intra- and extraperitoneal CO2 insufflation for TERP resulted in significant, but mostly clinically unimportant, hemodynamic alterations. Carbon dioxide absorption was more pronounced with extraperitoneal insufflation.
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References
JJG Bannenberg BMP Rademaker FMJA Froeling DW Meijer (1997) ArticleTitleHemodynamics during laparoscopic extra- and intraperitoneal insufflation. Surg Endosc 11 911–914 Occurrence Handle10.1007/s004649900485 Occurrence Handle1:STN:280:ByiH3sbptFI%3D Occurrence Handle9294271
J Binder J Jones W Bentas M Wolfram R Brautigam M Probst W Kramer D Jonas (2002) ArticleTitleRobot-assisted laparoscopy in urology: radical prostatectomy and reconstructive retroperitoneal interventions. Urologe 41 144–149 Occurrence Handle10.1007/s00120-002-0178-2
J Binder W Kramer (2001) ArticleTitleRobotically assisted laparoscopic radical prostatectomy. BJU Int 87 408–410
DA Dorsay FI Greene CL Baysinger (1995) ArticleTitleHemodynamic changes during laparoscopic cholecystectomy monitored with transesophageal echocardiography. Surg Endosc 9 128–134 Occurrence Handle1:STN:280:ByqA38%2Fntl0%3D Occurrence Handle7597579
JM Gascock HN Winfield GO Lund JF Donovan ST Ping DL Griffiths (1996) ArticleTitleCarbon dioxide homeostasis during transperitoneal or extraperitoneal laparoscopic pelvic lymphadenectomy: a real-time intraoperative comparison. J Endourol 10 319–323 Occurrence Handle1:STN:280:ByiD38nlsV0%3D Occurrence Handle8872727
JL Joris DP Noirot MJ Legrand NJ Jacquet ML Lamy (1993) ArticleTitleHemodynamic changes during laparoscopic cholecystectomy. Anesth Analg 76 1067–1071 Occurrence Handle1:STN:280:ByyB2cbgsFE%3D Occurrence Handle8484509
DR Lister B Rudston-Brown CB Warriner J McEwen M Chan KR Walley (1994) ArticleTitleCarbon dioxide absorption is not linearly related to intraperitoneal carbon dioxide insufflation pressure in pigs. Anesthesiology 80 129–136 Occurrence Handle1:STN:280:ByuC387isFI%3D Occurrence Handle8291701
D Loulmet A Carpentier N d’Attellis AJ Berrebi C Cardon O Ponzio B Aupecle JY Relland (1999) ArticleTitleEndoscopic coronary artery bypass grafting with the aid of robotic assisted instruments. J Thorac Cardiovasc Surg 118 4–10 Occurrence Handle1:STN:280:DyaK1MzhsF2lsQ%3D%3D Occurrence Handle10384177
D Meininger C Byhahn M Bueck J Binder W Kramer P Kessler K Westphal (2002) ArticleTitleEffects of prolonged pneumoperitoneum on hemodynamics and acid–base balance during totally endoscopic robot-assisted radical prostatectomies. World J Surg 26 1423–1427 Occurrence Handle10.1007/s00268-002-6404-7 Occurrence Handle12297911
O Mikami S Kawakita K Fujise K Shingu H Takahashi T Matsuda (1996) ArticleTitleCatecholamine release caused by carbon dioxide insufflation during laparoscopic surgery. J Urol 155 1368–1371 Occurrence Handle1:STN:280:BymB3s%2Fhsl0%3D Occurrence Handle8632576
C Mullet J Viale P Sagnard C Miellet L Ruynat H Counioux J Motin D Dargent G Annat (1993) ArticleTitlePulmonary CO2 elemination during surgical procedures using intra- or extraperitoneal CO2 insufflation. Anesth Analg 76 622–626
W Schuessler P Schulam R Clayman L Kavoussi (1997) ArticleTitleLaparoscopic radical prostatectomy: initial short-term experience. Urology 50 854–857 Occurrence Handle10.1016/S0090-4295(97)00543-8 Occurrence Handle1:STN:280:DyaK1c%2FovVWiuw%3D%3D Occurrence Handle9426713
NJ Soper JA Barteau RV Clayman SW Ashley DL Dunnegan (1992) ArticleTitleComparison of early postoperative results for laparoscopic versus standard open cholecystectomy. Surg Gynecol Obstet 174 114–118 Occurrence Handle1:STN:280:By2C3s3nvVY%3D Occurrence Handle1531160
JS Wolf SuffixJr TG Monk EM McDougall BL McClennan RV Clayman (1995) ArticleTitleThe extraperitoneal approach and subcutaneous emphysema are associated with greater absorption of carbon dioxide during laparoscopic renal surgery. J Urol 154 959–963 Occurrence Handle7637101
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Meininger, D., Byhahn, C., Wolfram, M. et al. Prolonged intraperitoneal versus extraperitoneal insufflation of carbon dioxide in patients undergoing totally endoscopic robot-assisted radical prostatectomy. Surg Endosc 18, 829–833 (2004). https://doi.org/10.1007/s00464-003-9086-9
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DOI: https://doi.org/10.1007/s00464-003-9086-9