Abstract
Nowadays, kidney transplantation is done through laparoscopic living donor nephrectomy performed by insufflating CO2 gas into intraperitoneum space using standard pressure (12–15 mmHg). However, it is also hypothesized that with lower pressure (8–10 mmHg) could be used for laparoscopic living donor nephrectomy related with lower postoperative pain and side effects. This was a prospective comparative study done in Department of Urology, Cipto Mangunkusumo General Hospital from November 2015 to August 2016. All subjects underwent laparoscopic living donor nephrectomy (LLDN). In this period, the subjects received a low pressure pneumoperitoneum procedure. This group was later compared randomly to a standard pressure pneumoperitoneum procedure group who underwent previous LLDN procedure. Out of 85, subjects underwent LLDN with low and standard pressure were 41 and 44, respectively. Despite nonsignificant difference of post op pain and duration of operation, the side effect in low pressure was lower than standard (p = 0.033 for epigastric pain, p = 0.024 for nausea, and p = 0.018 for vomiting). However, 22% subjects with low pressure need to be converted to standard pressure. Based on stratified analysis, the cause of conversion was higher BMI (p < 0.001). In conclusion, LLDN using low pressure pneumoperitoneum is proven to be as effective as LLDN using standard pressure pneumoperitoneum in providing good intraoperative and postoperative outcomes. Thus, this study suggests the use of low pressure pneumoperitoneum as an alternative procedure in LLDN surgeries. Further studies, however, are needed to assess the adverse outcomes of LLDN procedure using low pressure, as well as to assess the risk of conversion to standard pressure, i.e., BMI.
Published Version
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