Retroperitoneoscopy versus laparoscopy in piglets: ventilatory and thermic repercussions

Area of Science:

• Pediatric surgery
• Minimally invasive surgery
• Surgical innovation

Background:

• Endoscopic retroperitoneal surgery in children is an emerging field.
• Preliminary clinical observations suggested fewer ventilatory disturbances with retroperitoneum pneumoperitoneum (RPNOP) compared to laparoscopic pneumoperitoneum (PNOP).

Purpose of the Study:

• To investigate and compare the ventilatory repercussions of RPNOP versus PNOP in an animal model.
• To assess the safety and efficacy of RPNOP for creating a surgical workspace in pediatric patients.

Main Methods:

• A randomized animal study was conducted on six 10 kg suckling pigs.
• Pigs underwent both right RPNOP (kidney and vena cava dissection) and PNOP at a CO2 insufflation pressure of 10 mm Hg, with an 8-day interval between procedures.
• Ventilatory parameters including end-tidal CO2 (P(ET)CO2) and peak airway pressures (PawP) were monitored.

Main Results:

• P(ET)CO2 remained stable during RPNOP but increased during PNOP (P = .035).
• Peak airway pressures (PawP) increased significantly during PNOP, while remaining unchanged during RPNOP (P = .0001).
• Body temperature decreased over time in both procedures without significant difference (P = .34).

Conclusions:

• RPNOP at 10 mm Hg insufflation pressure created a satisfactory surgical workspace without adverse ventilatory effects.
• Pediatric endoscopic surgery utilizing RPNOP may lead to reduced respiratory complications compared to laparoscopy at similar insufflation pressures.