Laparoskopija sa niskim intrabadominalnim pritiskom i bezplinska laparoskopija u abdominalnoj hirurgiji

Abstract

Knowledge of pathophysiological basis of laparoscopic procedures, that is, the influence of CO2 pneumoperitoneum (PNP) on the body in particular, can prevent the complications during laparoscopy to occur. Standard intra-abdominal pressure (IAP), which is used during laparoscopic surgery, is 12-15 mm / Hg. The direct effect of CO2 pneumoperitoneum is a result of mechanical action of the gas and incensement of intra-abdominal pressure (IAP). The indirect effect of CO2 pneumoperitoneum is caused by the absorption of gas inserted into the abdomen. Analysis of published articles that assess the effects of CO2 pneumoperitoneum on the body and abdominal organs contributes to a better usage of the laparoscopic method. Different techniques in laparoscopy, created as an alternative to standard CO2-pneumoperitoneum, have the task to reduce the risks for patients with comorbidity and simultaneously raise the abdominal wall and allow the surgeon to perform smooth operation, which is especially important for ASA III and ASA IV patients. Alternative techniques can be divided into three groups: laparoscopy using pneumoperitoneum with low intra-abdominal pressure (up to 8 mm / Hg), laparoscopy using retractors abdominal wall and limited pneumoperitoneum, and laparoscopy without the use of gas (gasless laparoscopy; raising the abdominal wall retractor only ). Low insufflation pressure in the abdomen (up to 8 mm / Hg) is beneficial for patients with laparoscopic procedures and its routine usage in elderly patients and patients with severe cardiorespiratory diseases, should be common practice. Gasless laparoscopy was created because of the need to prevent the negative effects of increased intra-abdominal pressure on the body during laparoscopy, primarily in patients with high comorbidity (ASA III and ASA IV). When compared to other techniques, numerous studies prefer laparoscopy with low insufflation pressure, but in practice this is not done routinely, yet each technique is applied selectively, according to the needs and condition of the patient, which is the most appropriate. To avoid the side effects of CO2 pneumoperitoneum, which is important in high-risk patients, it is more likely to operate on low IAP (6-8 mm / Hg) or use gasless laparoscopy. This is especially important for long - duration operations.