Retroperitoneal versus transperitoneal laparoscopy for simple nephrectomy

BackgroundLaparoscopic surgery is a safe and reliable option for renal procedures. Many renal procedures are performed laparoscopically through two approaches namely transperitoneal and retroperitoneal. We assessed at similar insufflation pressure alterations in hemodynamic, ventilatory and cerebral variables during retroperitoneal and transperitoneal CO2 insufflation.Patients and methodsThirty adult patients of ASA I, II were randomly allocated into two groups; retroperironeal group (Ret group, n = 15) and transperitoneal group (Tran group, n = 15) for simple laparoscopic nephrectomy under general anesthesia. After carbon dioxide insufflation, cardiovascular and respiratory variables were measured at predetermined times with the same insufflation pressure while ventilation was adjusted to maintain normal end tidal CO2. Also, cerebral blood flow velocity (CBFV) was measured by using transcranial doppler ultrasonography.ResultsMean arterial pressure and heart rate were significantly greater with transperitoneal (Tran) than retroperitoneal (Ret) group during CO2 insufflation period. While both groups required increased minute ventilation to adjust ETCO2, transperitoneal CO2 insufflation resulted in a significantly greater increase of PaCO2 than retroperitoneal group at the same insufflation pressure. Furthermore, significantly greater peak airway pressure was required with Tran group than Ret group to administer the same minute ventilation. Following CO2 decompression, all these variables did not differ significantly from preinsufflation values. Peak airway pressure also decreased after decompression; however, values still differed significantly when compared to preinsufflation in transperitoneal group. Transperitoneal CO2 insufflation resulted in a rapid increase in CBFV during the first 30 min of pneumoperitoneum and attained a plateau throughout the procedure. In contrast, CBFV increased gradually throughout the retroperitoneal CO2 insufflation and both groups returned to baseline values after desufflation.ConclusionRetroperitoneal laparoscopic approach for simple nephrectomy is not associated with greater effects on ventilatory, hemodynamic and cerebral functions compared to transperitoneal laparoscopy.