Ventilatory and hemodynamic changes during retroperitoneal and transperitoneal laparoscopic nephrectomy: a prospective real-time comparison.

PURPOSE: Nephrectomies are currently performed via the transperitoneal or retroperitoneal laparoscopic approach. We compared the ventilatory and hemodynamic effects of these approaches.

MATERIALS AND METHODS: After institutional ethics committee approval was obtained patients requiring nephrectomy in a 9-month period were prospectively allocated to the retroperitoneal (24) or transperitoneal (15) approach. All were initially ventilated in the volume controlled mode (10 ml kg tidal volume). Intraoperative fingertip, pulse derived arterial oxygen saturation less than 97%, end tidal CO2 partial pressure greater than 40 mm Hg and peak inspiratory pressure greater than 36 cm H2O necessitated changes in ventilatory parameters, as deemed necessary by the anesthetist. If tidal volume decreased greater than 25% of baseline, pressure controlled ventilation was begun instead.

RESULTS: Peak inspiratory and plateau pressures increased for the transperitoneal approach by approximately 30% more than in the retroperitoneal group (p <0.05). Volume controlled ventilation was changed to pressure controlled ventilation in 8 transperitoneal vs zero retroperitoneal cases (p <0.05). Heart rate, and systolic and diastolic blood pressure increased by approximately 13% more in the transperitoneal than in the retroperitoneal group (p <0.05).

CONCLUSIONS: Nephrectomy via the retroperitoneal laparoscopic approach interferes with ventilatory and hemodynamic functions less than nephrectomy via the transperitoneal approach.