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Retroperitoneoscopic surgery is not associated with increased carbon dioxide absorption
1Section of Laparoscopic and Minimally Invasive Surgery, Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA.
The Journal of Urology
|September 24, 1999
Summary
Retroperitoneal laparoscopy did not show increased carbon dioxide absorption compared to transperitoneal approaches in renal and adrenal surgery. Subcutaneous emphysema was more common in retroperitoneal cases but only caused transient CO2 absorption increases.
Area of Science:
- Minimally Invasive Surgery
- Urologic Surgery
- Surgical Outcomes
Background:
- Previous research indicated retroperitoneal laparoscopy may lead to higher carbon dioxide absorption and postoperative complications.
- Concerns exist regarding subcutaneous emphysema and pneumothorax with the retroperitoneal approach.
Purpose of the Study:
- To prospectively compare carbon dioxide absorption during transperitoneal versus retroperitoneal laparoscopic renal and adrenal surgery.
- To evaluate the association between surgical approach and postoperative morbidity.
Main Methods:
- Prospective data collection from 51 patients undergoing laparoscopic renal or adrenal surgery.
- Comparison of transperitoneal (18 patients) and retroperitoneal (33 patients) approaches.
- Data collected between September 1997 and February 1998.
Main Results:
- No significant difference in carbon dioxide elimination was observed between transperitoneal and retroperitoneal groups.
- Subcutaneous emphysema occurred in 12.5% of transperitoneal and 45% of retroperitoneal cases (p = 0.09).
- Patients with subcutaneous emphysema showed transiently increased carbon dioxide absorption.
Conclusions:
- Contrary to prior studies, retroperitoneoscopy was not linked to greater carbon dioxide absorption than transperitoneal laparoscopy.
- Subcutaneous emphysema in retroperitoneal cases resulted in only temporary elevations in carbon dioxide absorption.
- Findings suggest the retroperitoneal approach is comparable regarding CO2 absorption in these procedures.