Neuroendocrine response to laparoscopic cholecystectomy with abdominal wall lift or conventional method

Abstract

Increases in plasma renin activity (PRA) and noradrenaline (NA) concentrations in a response to CO2 insufflation during laparoscopic cholecystectomy (LC) have been measured [1]. We compare conventional CO2-pneumoperitoneum (CPP) to abdominal wall lift method (AWL) [2] for LC with special reference to release of PRA and NA. Twenty-four ASA I-II patients undergoing elective LC with standardized anaesthesia were randomly allocated to two groups. Patients in one group underwent LC with CO2 insufflation to achieve CPP. In the other group the AWL method was used by elevating the abdominal wall 10-15 cm upwards with a Hoffmans trocare necessitating minimal CO2 insufflation for the surgical view. Intra-abdominal pressure (IAP) was continuously measured. Blood samples for PRA and NA were collected from the subclavian vein before and during insufflation. Total amount of CO2 was 42 (±23 SD) L with CPP and 9 (7) L with AWL method (P<0.001). The figures for IAP at 15 min of insufflation were 11 (2) mmHg and 3 (9) mmHg, respectively (P<0.01). In the CPP group, PRA increased from 5.5 (2.1) ng mL−1 to 6.1 (2) ng mL−1 during the first 55 min of LC. In the AWL group, these figures were 5.3 (2.7) ng mL−1 and 3.8 (0.9) ng mL−1 (P<0.01), respectively (Fig. 1). Increase in NA was significant in both groups (P<0.001), but the increase in NA was slightly higher in the CPP group during the first 15 min of insufflation (Fig. 1b).Fig. 1: (abstract 1). Changes in plasma renin activity and noradrenaline concentrations with conventional CO2 pneumoperitoneum (CPP) and abdominal wall lift (AWL).Renal function deteriorates at high IAP [3]. Insufflation of cool CO2 into abdominal cavity may dose dependently cause renal vasoconstriction. Avoiding excessive CO2 insufflation and high IAP with AWL resulted in a smaller PRA response and reduced NA release.