Hemodynamic and Respiratory Effect of Pediatric Urological Laparoscopic Surgery: A Retrospective Study

Abstract

We investigate the impact of extraperitoneal and intraperitoneal CO2 insufflation on cardiopulmonary variables in children undergoing laparoscopic surgery. The records of 73 patients who underwent laparoscopic urological surgery between December 2000 and April 2002 were retrospectively reviewed. Data collection included respiratory rate (RR), peak airway pressure (PAP), O2 saturation, end tidal CO2 (ETCO2), heart rate, systolic and diastolic blood pressure, electrocardiogram and insufflation pressure. All variables were recorded before and after CO2 insufflation. Only patients with complete records were included in the analysis. The study included 62 participants. Of the patients 16 boys and 13 girls with a mean age +/- SD of 7.2 +/- 5.1 years underwent extraperitoneal surgeries, 14 partial or total nephrectomy and 5 pyeloplasty. Mean retroperitoneal CO2 insufflation pressure was 12.1 +/- 1.5 mm Hg and mean operative time was 3.6 +/- 1 hours. We operated on 13 children on the right and 16 on the left decubitus lateral position. Significant increase in ETCO2, RR and PAP was recorded after CO2 insufflation in the extraperitoneal group. Use of the left lateral position resulted in a significant increase in ETCO2 (37.1 +/- 3.6 vs 40 +/- 3.8, p = 0.04) after CO2 insufflation compared to the right decubitus lateral position. Transperitoneal surgery was performed in 32 boys and 1 girl with a mean age of 3.8 +/- 4.1 years for cryptorchidism (32) and attempted pyeloplasty (1). Mean intraabdominal CO2 insufflation pressure was 11 +/- 2.4 mm Hg and mean operative time was 1.7 +/- 0.8 hours. A significant increase in RR (16.5 +/- 3.1 vs 17.9 +/- 3.4, p = 0.0002) and PAP (13.2 +/- 4.8 vs 16.1 +/- 5.7, p <0.0001), and a decrease in O2 saturation (99.6 +/- 0.6 vs 98.7 +/- 7.1, p = 0.0003) and heart rate (116 +/- 19 vs 113 +/- 18, p = 0.019) were recorded after CO2 insufflation. Our study documented significant hemodynamic and respiratory changes during pediatric laparoscopic surgeries. A similar effect on the respiratory parameters was observed in both groups. Although there were no apparent complications associated with either approach, further prospective studies are warranted to confirm the effect of laparoscopic urological surgery on cardiopulmonary function in children.