Hemodynamic changes after retroperitoneal CO2 insufflation for posterior retroperitoneoscopic adrenalectomy

Intraoperative complications and hemodynamic alterations during posterior capnoretroperitoneoscopic adrenalectomy in the prone position were investigated in 16 consecutive patients using invasive hemodynamic monitoring. Under general anesthesia with propofol and fentanyl, hemodynamic changes were made before (M1) and during retroperitoneal CO2 insufflation (15 mm Hg) [M2]; 20 mm Hg [M3]. Retroperitoneal insufflation resulted in a significant increase of cardiac output (+72%), stroke volume (+42%), mean arterial pressure (+39 %), and mean pulmonary arterial pressure (+36%). Although retroperitoneal inflation was accompanied by a significant increase of central venous pressure (+37%), an increase of preload may have lead to higher filling pressures. Heart rate, systemic vascular resistance, and pulmonary vascular resistance did not show significant changes. One pneumothorax and two cutaneous emphysemas occurred. We have demonstrated, in a small number of patients, that retroperitoneal CO2 insufflation for posterior capnoretroperitoneoscopic adrenalectomy in the prone position results in hemodynamic changes without apparent adverse effects.