Retroperitoneoscopy versus laparoscopy in piglets: ventilatory and thermic repercussions

Endoscopic surgery of the retroperitoneal space in children is developing. During preliminary clinical experience, the authors were surprised by the differences observed in comparison with laparoscopic pneumpoeritoneum (PNOP); retropneumpoeritoneum (RPNOP) seemed to have less ventilatory repercussions.

The authors therefore undertook a study on animal models. Six suckling pigs, newly weaned, each weighing 10 kg successively underwent, at 8-day intervals and in random sequence, a right RPNOP with kidney and vena cava dissection, with insufflation of CO2 at 10 mm Hg of pressure and a PNOP with the same pressure of 10 mm Hg.

P(ET)CO2 increased during PNOP, and it remained stable during during RPNOP (P = .035). The ventilatory peak airway pressures (PawP) increased during PNOP, but were not modified during RPNOP (P = .0001). Temperature decreased with time (P = .0001) without difference between the two procedures (P = .34).

RPNOP was not associated with any adverse effects on the ventilation despite the insufflation pressure of 10 mm Hg, which allowed a satisfactory working area to be created. Operations by RPNOP could be developed in children with fewer respiratory repercussions than those observed during laparoscopy at an equivalent level of pressure.