Document Detail


Laparoscopic cholecystectomy using abdominal wall retraction. Hemodynamics and gas exchange, a comparison with conventional pneumoperitoneum.
MedLine Citation:
PMID:  9171125     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Disadvantages related to CO2 pneumoperitoneum have led to development of the abdominal wall retractor (AWR), a device designed to facilitate laparoscopic surgery without conventional pneumoperitoneum (15 mmHg CO2). We investigated the effects of the AWR on hemodynamics and gas exchange in humans. We also investigated whether the use of an AWR imposed extra technical difficulties for the surgeon. A pilot study revealed that cholecystectomy without low-pressure pneumoperitoneum was technically impossible. METHODS: A prospective randomized controlled trial: Twenty patients undergoing laparoscopic cholecystectomy were randomly allocated into group 1: AWR with low-pressure pneumoperitoneum (5 mmHg), or group 2: conventional pneumoperitoneum (15 mmHg). RESULTS: Surgery using the AWR lasted longer, 72 +/- 16 min (mean +/- SD) vs 50 +/- 18 min compared with standard laparoscopic cholecystectomy. There were no differences between the groups with respect to hemodynamic parameters, although a small reduction of the cardiac output was observed using conventional pneumoperitoneum (from 3.9 +/- 0.7 to 3. 2 +/- 1.1 l/min) and an increase during AWR (from 4.2 +/- 0.9 to 5.2 +/- 1.5 l/min). Peak inspiratory pressures were significantly higher during conventional pneumoperitoneum compared to AWR. A slight decrease in pH accompanied by an increase in CO2 developed during pneumoperitoneum and during the use of the AWR. In both groups arterial PO2 decreased. CONCLUSIONS: The results indicate that the view was impaired during use of the AWR and therefore its use was difficult and time-consuming. Possible advantages of this devices' effects on hemodynamics and ventilatory parameters could not be confirmed in this study.
Authors:
D W Meijer; B P Rademaker; S Schlooz; W A Bemelman; L T de Wit; J J Bannenberg; T Stijnen; D F Gouma
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Surgical endoscopy     Volume:  11     ISSN:  0930-2794     ISO Abbreviation:  Surg Endosc     Publication Date:  1997 Jun 
Date Detail:
Created Date:  1997-06-24     Completed Date:  1997-06-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  645-9     Citation Subset:  IM    
Affiliation:
Working Group Development Surgical Technology, Surgical Division, Academic Medical Centre, IWO-gebouw 1 etage k151, University of Amsterdam, Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Abdominal Muscles / surgery*
Adult
Blood Gas Analysis
Carbon Dioxide / administration & dosage
Cholecystectomy, Laparoscopic / methods*
Cholelithiasis / surgery
Equipment Design
Female
Hemodynamics / physiology*
Humans
Hydrogen-Ion Concentration
Male
Middle Aged
Pneumoperitoneum, Artificial / adverse effects,  instrumentation*
Prospective Studies
Pulmonary Gas Exchange / physiology*
Pulmonary Ventilation
Safety
Treatment Outcome
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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