Surgical Research ReviewEffect of laparoscopy on intra-abdominal blood flow*
Section snippets
Alterations of hepatic blood flow
Impairment of the hepatic circulation, in particular portal blood flow, induced by intra-abdominal insufflation of different gases (eg, CO2, helium, and argon) or fluid has been documented in various experimental and clinical studies. Measurements of blood flow were performed either by using direct methods (Doppler and transit-time ultrasonography or intravascular catheters) or indirect methodology (indocyanine green clearance, thermodilution and γ-labeled microsphere technique). Table I
Alterations of splanchnic and renal blood flow
As shown in Table II, intestinal circulation of hollow viscus organs (stomach and small and large bowel) and of solid organs (liver, spleen, pancreas, and kidneys) reveals a decrease in blood flow during laparoscopy with increased IAP similar to that of hepatic blood flow.8, 9, 12, 16, 17Study Model Method IAP (mm Hg) Mesenteric arterial flow Gastric (mucosal) pH Hollow/solid organ blood flow Reversibility Blobner et al16 Pigs Iv catheter 4-12
Conclusion
The benefit offered by laparoscopy is the minimal access into the peritoneal cavity, the main impact of which involves the postoperative recovery. The surgical procedure itself remains unchanged. However, the technique of laparoscopic surgery necessitates methodological requirements that may be associated with adverse effects on the patient's intraoperative physiology. Numerous studies using various animal and human models and sophisticated measurement techniques have shown a variety of adverse
References (22)
- et al.
Does pneumoperitoneum with different gases, body positions, and intraperitoneal pressures influence renal and hepatic blood flow?
Surgery
(1997) - et al.
The role of intra-abdominal pressure on splanchnic and pulmonary hemodynamic and metabolic changes during carbon dioxide pneumoperitoneum
Gastrointest Endosc
(1999) - et al.
Portal venous flow during CO2 pneumoperitoneum in the rat
Surg Endosc
(1999) - et al.
Laparoscopic insufflation of the abdomen reduces portal venous flow
Surg Endosc
(1998) - et al.
Effects of abdominal CO2 insufflation and changes of position on hepatic blood flow in anesthetized pigs
Am J Physiol
(1998) - et al.
Pneumoperitoneum for laparoscopic cholecystectomy is not associated with compromised splanchnic circulation
Eur J Surg
(1998) - et al.
Effects of pneumoperitoneum on splanchnic hemodynamics: an experimental study in pigs
Eur J Surg
(1995) - et al.
Effects of carbon dioxide vs helium pneumoperitoneum on hepatic blood flow
Surg Endosc
(1998) - et al.
Liver and splanchnic hemodynamic changes in rats during laparoscopy
Surg Endosc
(2000) - et al.
Splanchnic microcirculatory changes during CO2 laparoscopy
J Am Coll Surg
(1997)
Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy
Surg Endosc
Cited by (67)
Portal vein thrombosis after laparoscopic sleeve gastrectomy: presentation and management
2016, Surgery for Obesity and Related DiseasesMontelukast prevents ischaemia/reperfusion-induced ovarian damage in rats
2014, European Journal of Obstetrics and Gynecology and Reproductive BiologyProtective effects of dexmedetomidine in pneumoperitoneum-related ischaemia-reperfusion injury in rat ovarian tissue
2013, European Journal of Obstetrics and Gynecology and Reproductive BiologyThe oxidative effect of prolonged CO <inf>2</inf> pneumoperitoneum A comparative study in rats
2012, Journal of Surgical ResearchCitation Excerpt :We compared a “routine” laparoscopic procedure of 1 h with a more “advanced” and lengthy procedure of 3 h. Laparoscopic procedures are known to be pressure-dependent [17, 30–32]. We took into consideration that the intra-abdominal pressure should be kept between 8 and 12 mmHg during laparoscopy to minimize alterations in blood flow and oxidative stress-related adverse effects [11]. We used an established and routinely used pressure of 10 mmHg that also induces oxidative stress, as does pressure set at 12 or 15 mmHg, but to a minor extent, without compromising intraoperative visualization and safety of laparoscopic procedures.
The Impact of Carbon Dioxide Pneumoperitoneum on Ovarian Ischemia-Reperfusion Injury during Laparoscopic Surgery: A Preliminary Study
2018, Journal of Minimally Invasive Gynecology
- *
Reprint requests: Lukas Krähenbühl, MD, Department of Visceral and Transplantation Surgery, University of Zurich, Rämistrasse, CH-8091 Zurich, Switzerland.