Pathophysiological consequences of pneumoperitoneum

Laparoscopic surgery has been performed for more than a century, although its nse was mainly restricted to diagnostic purposes 1. 2 Recent developments in instrumental design and methods of visualization have contributed to further implementation of laparoscopic techniques 3 In 1985, Muhe performed the first laparoscopic cholecystectomy 4 After further development of this technique by Moure! and Dubois 5· 6, laparoscopic techniques have gained wide acceptance in surgical practice. Except for laparoscopic gallbladder removal, minimally invasive techniques now have been established for other surgical procedures such as gastric ftmdoplication, appendectomy, splenectomy and (donor) nephrectomy 7-10 The popularity of these techniques may be explained by the growing evidence that the minimally invasive approach is associated with a reduction in operative morbidity, such as less postoperative pain, decreased systemic stress response, shorter hospitalization and improved cosmesis 11-15 The pneumoperitoneum is the crucial element in laparoscopic surgery. Each laparoscopic procedure requires a working space in the abdominal cavity to allow safe introduction of trocars and instruments and for exposure of the abdominal contents. Intraperitoneal insufflation of gas is the most common method to elevate the abdominal wall and suppress the viscera. Carbon dioxide (C02) is the preferred gas for establishing a pneumoperitoneum because it is non-flammable and inexpensive. However, C02 absorption through the peritoneal membrane leads to hypercapnia and acidosis and in order to reduce these effects, minute ventilation has to be adjusted. In addition, the increased intra-abdominal pressure due to intraperitoneal gas insufflation influences hemodynamic and respiratory ftmction.

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