Carbon dioxide absorption during laparoscopic donor nephrectomy: a comparison between retroperitoneal and...

Previous studies have suggested that retroperitoneal and transperitoneal approaches for laparoscopic donor nephrectomy are associated with variable carbon dioxide (CO(2)) absorption, which can cause significant morbidity. The approach that results in greater CO(2) absorption is a matter of debate. We studied patients undergoing transperitoneal/retroperitoneal donor nephrectomy to determine relative CO(2) absorption, incidence of subcutaneous emphysema, pneumothorax, and pneumomediastinum, seeking to establish a correlation between the incidence of subcutaneous emphysema and CO(2) elimination.

This was a prospective nonrandomized, single-center, two-arm clinical study of 60 kidney donors undergoing laparoscopic nephrectomy by transperitoneal (n = 30) or retroperitoneal (n = 30) approach. CO(2) elimination was calculated using end tidal CO(2), tidal volume, respiratory rate, and weight of the donor. We studied intraoperative CO(2) elimination and CO(2) retention-related morbidities.

There was a significant increase in CO(2) elimination in the first 30 minutes of insufflation followed by a plateau for the remainder of procedure. There was no difference in CO(2) elimination in either procedure at any time interval. Patients with subcutaneous emphysema showed significantly greater CO(2) elimination, which decreased with desufflation.

CO(2) absorption during laparoscopy did not depend on the route of surgery. Subcutaneous emphysema was strongly and independently associated with a greater degree of CO(2) absorption during laparoscopic surgery.