Comparison of Physiological Changes between Transperitoneal and Retroperitoneal Approach for Urologic Laparoscopic Surgery UC04-UC07
Dr. Rajnish Nama,
A501, Umiyatirth Avenue, Near Aditya Greens, New CG Road, Chandkheda, Ahmedabad-382424, Gujarat, India.
Introduction: Laparoscopy is increasingly being performed for urologic surgeries either through transperitoneal or retroperitoneal approach. While physiological changes during transperitoneal surgeries have been extensively studied, very few studies have explored the effect of retroperitoneal laparoscopy.
Aim: To compare physiological changes that occurred when urologic laparoscopic surgeries were carried out through either transperitoneal or retroperitoneal approach in lateral positions. Primary outcome was respiratory changes and haemodynamic changes were considered secondary outcome.
Materials and Methods: This single centre prospective non randomised human study was conducted in 46 healthy individuals undergoing elective urologic laparoscopic surgeries at Dr. H.L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India, from January 2017 to July 2017 and patients were divided into two groups according to the surgical approach used: 1) Transperitoneal (Trans) group; and 2) Retroperitoneal (Retro) group. Compliance, Peak Inspiratory Pressure (PIP), Minute Ventilation (MV), Heart Rate (HR) and Mean Arterial Pressure (MAP) were monitored at defined time interval. Arterial blood gases were also measured to compare Partial Pressure of Arterial Oxygen/Fraction of Inspired Oxygen (PaO2/FiO2) ratio. Chi-square and t-test were used for statistical comparison between the two groups. A p-value<0.05 was considered significant.
Results: PaO2/FiO2 ratio improved in Trans (from 395.45±128.35 to 439.88±87.77) and decreased in Retro group (from 399.29±57.6 to 349.72±97.89) at the end of pneumoperitoneum with significant statistical difference between the two groups. Compliance decreased to 37% of baseline (from 33.03 to 20.99 mL/cm H2O in Trans group and from 37.02 to 23.23 mL/cm H2O in Retro group) and PIP increased to 45% from baseline (from 18.43 to 26.13 cm H2O in Trans group and from 17.91 to 25.86 cm H2O in Retro group) in both the groups without any statistical difference. The HR remained higher in Trans group as compared to Retro group during the insufflation period. The MAP remained higher than baseline during pneumoperitoneum in both the groups. Statistical comparison of HR and MAP between the two groups was insignificant.
Conclusion: Respiratory and haemodynamic parameters remain stable and are comparable between the two approaches. Larger studies are required to validate this results.