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VENTILATORY AND HEMODYNAMIC CHANGES DURING RETROPERITONEAL AND TRANSPERITONEAL LAPAROSCOPIC NEPHRECTOMY: A PROSPECTIVE REAL-TIME COMPARISON

2005; Lippincott Williams & Wilkins; Volume: 174; Issue: 3 Linguagem: Inglês

10.1097/01.ju.0000169456.00399.de

1527-3792

Andrei Nadu, Perla Ekstein, Amir Szold, Alan D. Friedman, Richard Nakache, Yitzhak Cohen, Haim Matzkin, Avi A. Weinbroum,

Appendicitis Diagnosis and Management

No AccessJournal of UrologyAdult Urology: Transplantation/Vascular Surgery1 Sep 2005VENTILATORY AND HEMODYNAMIC CHANGES DURING RETROPERITONEAL AND TRANSPERITONEAL LAPAROSCOPIC NEPHRECTOMY: A PROSPECTIVE REAL-TIME COMPARISON ANDREI NADU, PERLA EKSTEIN, AMIR SZOLD, ALAN FRIEDMAN, RICHARD NAKACHE, YITZHAK COHEN, HAIM MATZKIN, and AVI A. WEINBROUM ANDREI NADUANDREI NADU , PERLA EKSTEINPERLA EKSTEIN , AMIR SZOLDAMIR SZOLD , ALAN FRIEDMANALAN FRIEDMAN , RICHARD NAKACHERICHARD NAKACHE , YITZHAK COHENYITZHAK COHEN , HAIM MATZKINHAIM MATZKIN , and AVI A. WEINBROUMAVI A. WEINBROUM View All Author Informationhttps://doi.org/10.1097/01.ju.0000169456.00399.deAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Nephrectomies are currently performed via the transperitoneal or retroperitoneal laparoscopic approach. We compared the ventilatory and hemodynamic effects of these approaches. Materials and Methods: After institutional ethics committee approval was obtained patients requiring nephrectomy in a 9-month period were prospectively allocated to the retroperitoneal (24) or transperitoneal (15) approach. All were initially ventilated in the volume controlled mode (10 ml kg-1 tidal volume). Intraoperative fingertip, pulse derived arterial oxygen saturation less than 97%, end tidal CO2 partial pressure greater than 40 mm Hg and peak inspiratory pressure greater than 36 cm H2O necessitated changes in ventilatory parameters, as deemed necessary by the anesthetist. If tidal volume decreased greater than 25% of baseline, pressure controlled ventilation was begun instead. Results: Peak inspiratory and plateau pressures increased for the transperitoneal approach by approximately 30% more than in the retroperitoneal group (p <0.05). Volume controlled ventilation was changed to pressure controlled ventilation in 8 transperitoneal vs zero retroperitoneal cases (p <0.05). Heart rate, and systolic and diastolic blood pressure increased by approximately 13% more in the transperitoneal than in the retroperitoneal group (p <0.05). Conclusions: Nephrectomy via the retroperitoneal laparoscopic approach interferes with ventilatory and hemodynamic functions less than nephrectomy via the transperitoneal approach. References 1 : Retroperitoneal laparoscopic versus open radical nephrectomy. J Urol1999; 161: 1776. Link, Google Scholar 2 : Complications of laparoscopic nephrectomy in 185 patients: a multi-institutional review. J Urol1995; 154: 479. Link, Google Scholar 3 : Laparoscopic nephrectomy for renal cell cancer: evaluation of efficacy and safety: a multicenter experience. Urology1998; 52: 773. Google Scholar 4 : Retroperitoneal laparoscopic nephrectomy. Urol Clin North Am1998; 25: 343. Google Scholar 5 : Editorial: Laparoscopy and urologic oncology—I now pronounce you man and wife. J Urol2003; 169: 2057. 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Google Scholar From the Departments of Urology (AN, HM) and Anesthesia and Critical Care (PE, AF, YC, AAW), and Units of Transplantation (AS, RN) and Post-Anesthesia Care (AAW), Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel© 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 3September 2005Page: 1013-1017 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.Keywordskidneylaparoscopynephrectomypulmonary ventilationMetricsAuthor Information ANDREI NADU More articles by this author PERLA EKSTEIN More articles by this author AMIR SZOLD More articles by this author ALAN FRIEDMAN More articles by this author RICHARD NAKACHE More articles by this author YITZHAK COHEN More articles by this author HAIM MATZKIN More articles by this author AVI A. WEINBROUM More articles by this author Expand All Advertisement PDF downloadLoading ...