Effects of Retroperitoneal or Transperitoneal Laparoscopic Surgery on Hemodynamic and Respiratory Function in Old Patients

Abstract

Purpose: To compare the effects of retroperitoneal laparoscopic surgery (RPL) and transperitoneal laparoscopic surgery (TPL) on the hemodynamic and ventilatory functions in old patients. Methods: Thirty-two senior patients underwent either RPL or TPL. Swan-Ganz and radial artery catheters were placed to monitor hemodynamic functions. Artery blood samples were obtained to analyze ventilatory functions. Results: For hemodynamic changes in both TPL and RPL, central venous pressure, mean pulmonary arterial pressure and pulmonary capillary wedge pressure significantly increased 10 min after CO₂ insufflation and decreased to preanesthesia levels roughly 30 min after insufflation relief. For ventilatory functions, in both TPL and RPL, peak airway pressure, partial pressure of arterial carbon dioxide (PaCO₂), end-tidal carbon dioxide tension (PetCO₂), carbon dioxide output (VCO₂), and the difference between PaCO₂ and PetCO₂ (Pa-PetCO₂) all increased significantly 10 min after CO₂ insufflation and returned to the preanesthesia level 20 min after CO₂ desufflation. However, increments of PaCO₂, VCO₂ and Pa-PetCO₂ were significantly higher in RPL than in TPL, and did not return to the preanesthesia level until 30 min after CO₂ desufflation. Conclusion: For senior patients, TPL and RPL have similar effects on hemodynamic functions. However, RPL tends to cause much more change in the respiratory measurements.