scholarly journals Effects of low versus standard pressure pneumoperitoneum on renal syndecan-1 shedding and VEGF receptor-2 expression in living-donor nephrectomy: a randomized controlled study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dita Aditianingsih ◽  
Chaidir Arif Mochtar ◽  
Aida Lydia ◽  
Nuryati Chairani Siregar ◽  
Nur Ita Margyaningsih ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Low Pressure ◽  
Donor Nephrectomy ◽  
Intraabdominal Pressure ◽  
Vascular Endothelial ◽  
Pressure Group ◽  
Peritubular Capillary ◽  
Living Donor Nephrectomy ◽  
Standard Pressure ◽  
Renal Tubular

Abstract Background Laparoscopic nephrectomy is a preferred technique for living kidney donation. However, positive-pressure pneumoperitoneum may have an unfavorable effect on the remaining kidney and other distant organs due to inflamed vascular endothelium and renal tubular cell injury in response to increased systemic inflammation. Early detection of vascular endothelial and renal tubular response is needed to prevent further kidney injury due to increased intraabdominal pressure induced by pneumoperitoneum. Transperitoneal laparoscopic living donor nephrectomy represented a human model of mild increasing intraabdominal pressure. This study aimed to assess the effect of increased intraabdominal pressure on vascular endothelium and renal tubular cells by comparing the effects of low and standard pressure pneumoperitoneum on vascular endothelial growth factor receptor-2 (VEGFR-2) expression and the shedding of syndecan-1 as the early markers to a systemic inflammation. Methods We conducted a prospective randomized study on 44 patients undergoing laparoscopic donor nephrectomy. Subjects were assigned to standard (12 mmHg) or low pressure (8 mmHg) groups. Baseline, intraoperative, and postoperative plasma interleukin-6, syndecan-1, and sVEGFR-2 were quantified by ELISA. Syndecan-1 and VEGFR-2 expression were assessed immunohistochemically in renal cortex tissue. Renal tubule and peritubular capillary ultrastructures were examined using electron microscopy. Perioperative hemodynamic changes, end-tidal CO2, serum creatinine, blood urea nitrogen, and urinary KIM-1 were recorded. Results The low pressure group showed lower intra- and postoperative heart rate, intraoperative plasma IL-6, sVEGFR-2 levels and plasma syndecan-1 than standard pressure group. Proximal tubule syndecan-1 expression was higher in the low pressure group. Proximal-distal tubules and peritubular capillary endothelium VEGFR-2 expression were lower in low pressure group. The low pressure group showed renal tubule and peritubular capillary ultrastructure with intact cell membranes, clear cell boundaries, and intact brush borders, while standard pressure group showed swollen nuclei, tenuous cell membrane, distant boundaries, vacuolizations, and detached brush borders. Conclusion The low pressure pneumoperitoneum attenuated the inflammatory response and resulted in reduction of syndecan-1 shedding and VEGFR-2 expression as the renal tubular and vascular endothelial proinflammatory markers to injury due to a systemic inflammation in laparoscopic nephrectomy. Trial registration ClinicalTrials.gov NCT:03219398, prospectively registered on July 17th, 2017.

scholarly journals Effects of Low Versus Standard Pressure Pneumoperitoneum on Renal Syndecan-1 Shedding and VEGF Receptor-2 Expression in Living-donor Nephrectomy: A Randomized Controlled Study

2019 ◽  
Author(s):  
Dita Aditianingsih ◽  
Chaidir Arif Mochtar ◽  
Aida Lydia ◽  
Nuryati Chairani Siregar ◽  
Nur Ita Margyaningsih ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Low Pressure ◽  
Donor Nephrectomy ◽  
Laparoscopic Nephrectomy ◽  
Intraabdominal Pressure ◽  
Vascular Endothelial ◽  
Pressure Group ◽  
Peritubular Capillary ◽  
Standard Pressure ◽  
Renal Tubular

Abstract Background Laparoscopic nephrectomy is a preferred technique for living kidney donation. However, positive-pressure pneumoperitoneum may have an unfavorable effect on the remaining kidney and other distant organs due to inflamed vascular endothelium and renal tubular cell injury in response to increased systemic inflammation. Early detection of vascular endothelial and renal tubular response is needed to prevent further kidney injury due to increased intraabdominal pressure induced by pneumoperitoneum. Transperitoneal laparoscopic living donor nephrectomy represented a human model of mild increasing intraabdominal pressure. This study aimed to assess the effect of increased intraabdominal pressure on vascular endothelium and renal tubular cells by comparing the effects of low and standard pressure pneumoperitoneum on vascular endothelial growth factor receptor-2 (VEGFR-2) expression and the shedding of syndecan-1 as the early markers to a systemic inflammation. Methods We conducted a prospective randomized study on 44 patients undergoing laparoscopic donor nephrectomy. Subjects were assigned to standard (12 mmHg) or low pressure (8 mmHg) groups. Baseline, intraoperative, and postoperative plasma interleukin-6, syndecan-1, and sVEGFR-2 were quantified by ELISA. Syndecan-1 and VEGFR-2 expression were assessed immunohistochemically in renal cortex tissue. Renal tubule and peritubular capillary ultrastructures were examined using electron microscopy. Perioperative hemodynamic changes, end-tidal CO2, serum creatinine, blood urea nitrogen, and urinary KIM-1 were recorded. Results The low pressure group showed lower intra- and postoperative heart rate, intraoperative plasma IL-6, sVEGFR-2 levels and plasma syndecan-1 than standard pressure group. Proximal tubule syndecan-1 expression was higher in the low pressure group. Proximal-distal tubules and peritubular capillary endothelium VEGFR-2 expression were lower in low pressure group. The low pressure group showed renal tubule and peritubular capillary ultrastructure with intact cell membranes, clear cell boundaries, and intact brush borders, while standard pressure group showed swollen nuclei, tenuous cell membrane, distant boundaries, vacuolizations, and detached brush borders. Conclusion The low pressure pneumoperitoneum attenuated the inflammatory response and resulted in reduction of syndecan-1 shedding and VEGFR-2 expression as the renal tubular and vascular endothelial proinflammatory markers to injury due to a systemic inflammation in laparoscopic nephrectomy. Trial registration ClinicalTrial.gov NCT:03219398, July 17th 2017. Keywords: pneumoperitoneum, renal resistive index, interleukin-6, syndecan-1, sVEGFR-2, laparoscopic nephrectomy

scholarly journals Effects of Low Versus Standard Pressure Pneumoperitoneum on Renal Syndecan-1 Shedding and VEGF Receptor-2 Expression in Living-donor Nephrectomy: A Randomized Controlled Study

2019 ◽  
Author(s):  
Dita Aditianingsih ◽  
Chaidir Arif Mochtar ◽  
Aida Lydia ◽  
Nuryati Chairani Siregar ◽  
Nur Ita Margyaningsih ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Low Pressure ◽  
Donor Nephrectomy ◽  
Laparoscopic Nephrectomy ◽  
Intraabdominal Pressure ◽  
Vascular Endothelial ◽  
Pressure Group ◽  
Peritubular Capillary ◽  
Standard Pressure ◽  
Renal Tubular

Abstract Background Laparoscopic nephrectomy is a preferred technique for living kidney donation. However, positive-pressure pneumoperitoneum may have an unfavorable effect on the remaining kidney and other distant organs due to inflamed vascular endothelium and renal tubular cell injury in response to increased systemic inflammation. Early detection of vascular endothelial and renal tubular response is needed to prevent further kidney injury due to increased intraabdominal pressure induced by pneumoperitoneum. Transperitoneal laparoscopic living donor nephrectomy represented a human model of mild increasing intraabdominal pressure. This study aimed to assess the effect of increased intraabdominal pressure on vascular endothelium and renal tubular cells by comparing the effects of low and standard pressure pneumoperitoneum on vascular endothelial growth factor receptor-2 (VEGFR-2) expression and the shedding of syndecan-1 as the early markers to a systemic inflammation. Methods We conducted a prospective randomized study on 44 patients undergoing laparoscopic donor nephrectomy. Subjects were assigned to standard (12 mmHg) or low pressure (8 mmHg) groups. Baseline, intraoperative, and postoperative plasma interleukin-6, syndecan-1, and sVEGFR-2 were quantified by ELISA. Syndecan-1 and VEGFR-2 expression were assessed immunohistochemically in renal cortex tissue. Renal tubule and peritubular capillary ultrastructures were examined using electron microscopy. Perioperative hemodynamic changes, end-tidal CO2, serum creatinine, blood urea nitrogen, and urinary KIM-1 were recorded. Results The low pressure group showed lower intra- and postoperative heart rate, intraoperative plasma IL-6, sVEGFR-2 levels and plasma syndecan-1 than standard pressure group. Proximal tubule syndecan-1 expression was higher in the low pressure group. Proximal-distal tubules and peritubular capillary endothelium VEGFR-2 expression were lower in low pressure group. The low pressure group showed renal tubule and peritubular capillary ultrastructure with intact cell membranes, clear cell boundaries, and intact brush borders, while standard pressure group showed swollen nuclei, tenuous cell membrane, distant boundaries, vacuolizations, and detached brush borders. Conclusion The low pressure pneumoperitoneum attenuated the inflammatory response and resulted in reduction of syndecan-1 shedding and VEGFR-2 expression as the renal tubular and vascular endothelial proinflammatory markers to injury due to a systemic inflammation in laparoscopic nephrectomy. Trial registration ClinicalTrial.gov NCT:03219398, July 17th 2017. Keywords: pneumoperitoneum, renal resistive index, interleukin-6, syndecan-1, sVEGFR-2, laparoscopic nephrectomy

scholarly journals Effects of Low Versus Standard Pressure Pneumoperitoneum on Renal Syndecan-1 Shedding and VEGF Receptor-2 Expression in Living-donor Nephrectomy: A Randomized Controlled Study

2020 ◽  
Author(s):  
Dita Aditianingsih ◽  
Chaidir Arif Mochtar ◽  
Aida Lydia ◽  
Nuryati Chairani Siregar ◽  
Nur Ita Margyaningsih ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Low Pressure ◽  
Donor Nephrectomy ◽  
Laparoscopic Nephrectomy ◽  
Intraabdominal Pressure ◽  
Vascular Endothelial ◽  
Pressure Group ◽  
Peritubular Capillary ◽  
Standard Pressure ◽  
Renal Tubular

Abstract Background Laparoscopic nephrectomy is a preferred technique for living kidney donation. However, positive-pressure pneumoperitoneum may have an unfavorable effect on the remaining kidney and other distant organs due to inflamed vascular endothelium and renal tubular cell injury in response to increased systemic inflammation. Early detection of vascular endothelial and renal tubular response is needed to prevent further kidney injury due to increased intraabdominal pressure induced by pneumoperitoneum. Transperitoneal laparoscopic living donor nephrectomy represented a human model of mild increasing intraabdominal pressure. This study aimed to assess the effect of increased intraabdominal pressure on vascular endothelium and renal tubular cells by comparing the effects of low and standard pressure pneumoperitoneum on vascular endothelial growth factor receptor-2 (VEGFR-2) expression and the shedding of syndecan-1 as the early markers to a systemic inflammation. Methods We conducted a prospective randomized study on 44 patients undergoing laparoscopic donor nephrectomy. Subjects were assigned to standard (12 mmHg) or low pressure (8 mmHg) groups. Baseline, intraoperative, and postoperative plasma interleukin-6, syndecan-1, and sVEGFR-2 were quantified by ELISA. Syndecan-1 and VEGFR-2 expression were assessed immunohistochemically in renal cortex tissue. Renal tubule and peritubular capillary ultrastructures were examined using electron microscopy. Perioperative hemodynamic changes, end-tidal CO2, serum creatinine, blood urea nitrogen, and urinary KIM-1 were recorded. Results The low pressure group showed lower intra- and postoperative heart rate, intraoperative plasma IL-6, sVEGFR-2 levels and plasma syndecan-1 than standard pressure group. Proximal tubule syndecan-1 expression was higher in the low pressure group. Proximal-distal tubules and peritubular capillary endothelium VEGFR-2 expression were lower in low pressure group. The low pressure group showed renal tubule and peritubular capillary ultrastructure with intact cell membranes, clear cell boundaries, and intact brush borders, while standard pressure group showed swollen nuclei, tenuous cell membrane, distant boundaries, vacuolizations, and detached brush borders. Conclusion The low pressure pneumoperitoneum attenuated the inflammatory response and resulted in reduction of syndecan-1 shedding and VEGFR-2 expression as the renal tubular and vascular endothelial proinflammatory markers to injury due to a systemic inflammation in laparoscopic nephrectomy. Trial registration ClinicalTrial.gov NCT:03219398, July 17th 2017. Keywords: pneumoperitoneum, renal resistive index, interleukin-6, syndecan-1, sVEGFR-2, laparoscopic nephrectomy

scholarly journals Effects of Low Versus Standard Pressure Pneumoperitoneum on Renal Syndecan-1 Shedding and VEGF Receptor-2 Expression in Living-donor Nephrectomy: A Randomized Controlled Study

2020 ◽  
Author(s):  
Dita Aditianingsih ◽  
Chaidir Arif Mochtar ◽  
Aida Lydia ◽  
Nuryati Chairani Siregar ◽  
Nur Ita Margyaningsih ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Low Pressure ◽  
Donor Nephrectomy ◽  
Laparoscopic Nephrectomy ◽  
Intraabdominal Pressure ◽  
Vascular Endothelial ◽  
Pressure Group ◽  
Peritubular Capillary ◽  
Standard Pressure ◽  
Renal Tubular

Abstract Background Laparoscopic nephrectomy is a preferred technique for living kidney donation. However, positive-pressure pneumoperitoneum may have an unfavorable effect on the remaining kidney and other distant organs due to inflamed vascular endothelium and renal tubular cell injury in response to increased systemic inflammation. Early detection of vascular endothelial and renal tubular response is needed to prevent further kidney injury due to increased intraabdominal pressure induced by pneumoperitoneum. Transperitoneal laparoscopic living donor nephrectomy represented a human model of mild increasing intraabdominal pressure. This study aimed to assess the effect of increased intraabdominal pressure on vascular endothelium and renal tubular cells by comparing the effects of low and standard pressure pneumoperitoneum on vascular endothelial growth factor receptor-2 (VEGFR-2) expression and the shedding of syndecan-1 as the early markers to a systemic inflammation. Methods We conducted a prospective randomized study on 44 patients undergoing laparoscopic donor nephrectomy. Subjects were assigned to standard (12 mmHg) or low pressure (8 mmHg) groups. Baseline, intraoperative, and postoperative plasma interleukin-6, syndecan-1, and sVEGFR-2 were quantified by ELISA. Syndecan-1 and VEGFR-2 expression were assessed immunohistochemically in renal cortex tissue. Renal tubule and peritubular capillary ultrastructures were examined using electron microscopy. Perioperative hemodynamic changes, end-tidal CO2, serum creatinine, blood urea nitrogen, and urinary KIM-1 were recorded. Results The low pressure group showed lower intra- and postoperative heart rate, intraoperative plasma IL-6, sVEGFR-2 levels and plasma syndecan-1 than standard pressure group. Proximal tubule syndecan-1 expression was higher in the low pressure group. Proximal-distal tubules and peritubular capillary endothelium VEGFR-2 expression were lower in low pressure group. The low pressure group showed renal tubule and peritubular capillary ultrastructure with intact cell membranes, clear cell boundaries, and intact brush borders, while standard pressure group showed swollen nuclei, tenuous cell membrane, distant boundaries, vacuolizations, and detached brush borders. Conclusion The low pressure pneumoperitoneum attenuated the inflammatory response and resulted in reduction of syndecan-1 shedding and VEGFR-2 expression as the renal tubular and vascular endothelial proinflammatory markers to injury due to a systemic inflammation in laparoscopic nephrectomy. Trial registration ClinicalTrial.gov NCT:03219398, July 17th 2017. Keywords: pneumoperitoneum, renal resistive index, interleukin-6, syndecan-1, sVEGFR-2, laparoscopic nephrectomy

scholarly journals Effects of Low Versus Standard Pressure Pneumoperitoneum on Renal Syndecan-1 Shedding and VEGF Receptor-2 Expression in Living-donor Nephrectomy: A Randomized Controlled Study

2019 ◽  
Author(s):  
Dita Aditianingsih ◽  
Chaidir Arif Mochtar ◽  
Aida Lydia ◽  
Nuryati Chairani Siregar ◽  
Nur Ita Margyaningsih ◽  
...  
Keyword(s):  
Low Pressure ◽  
Donor Nephrectomy ◽  
Intraabdominal Pressure ◽  
Vascular Endothelial ◽  
Pressure Group ◽  
Peritubular Capillary ◽  
Living Donor Nephrectomy ◽  
Early Markers ◽  
Standard Pressure ◽  
Renal Tubular

Abstract Background Laparoscopic nephrectomy is a preferable technique for living kidney donation. However, due to increased systemic inflammation, endothelial vascular response, and renal tubular injury, positive-pressure pneumoperitoneum may have an unfavourable effect on the remaining kidney and other distant organs. Early detection of renal injury due to increased intraabdominal pressure induced by pneumoperitoneum is needed. This study aimed to assess the effect of low intraabdominal pressure on kidney injury prevention. Transperitoneal laparoscopic living donor nephrectomy was used as a human model of mild increasing intraabdominal pressure. We compared the effects of low and standard pressure pneumoperitoneum on the shedding of syndecan-1 and vascular endothelial growth factor receptor-2 (VEGFR-2) expression, as these are potential early markers of renal tubular and vascular endothelial cell injury due to a systemic inflammatory response. Methods We conducted a prospective randomized study on 44 patients undergoing laparoscopic donor nephrectomy. Subjects were assigned to standard (12 mmHg) or low-pressure (8 mmHg) groups. Baseline, intraoperative, and postoperative plasma interleukin-6, syndecan-1, and sVEGFR-2 were quantified by ELISA. Syndecan-1 and VEGFR-2 expression was assessed immunohistochemically in renal cortex tissue, and renal tubule and peritubular capillary ultrastructure was examined using electron microscopy. Perioperative hemodynamic changes, end-tidal CO2, serum creatinine, blood urea nitrogen, and urinary KIM-1 were recorded. Results The low-pressure group showed significantly lower intra- and postoperative heart rate, intraoperative plasma IL-6, and sVEGFR-2 levels than the standard pressure group. Although statistically insignificant, plasma syndecan-1 was also lower in the low-pressure group. Proximal tubule syndecan-1 expression was significantly higher in the low-pressure group. VEGFR-2 expression in the proximal and distal tubules and peritubular capillary endothelium was significantly lower in the low-pressure group. The low-pressure group showed better morphological renal tubule and peritubular capillary ultrastructure. Conclusion The low-pressure pneumoperitoneum reduced the shedding of syndecan-1 and VEGFR-2 expression, which are the potential early markers of renal tubular and vascular endothelial injury due to a systemic inflammatory response in laparoscopic nephrectomy. Trial registration ClinicalTrial.gov NCT:03219398 on July 17th 2017.

scholarly journals The Effects of Low versus Standard Pressure Pneumoperitoneum on Renal Tubular Epithelial and Peritubular Endothelial Cells Injury in Living-Donor Nephrectomy: A Randomized Controlled Study

2019 ◽  
Author(s):  
Dita Aditianingsih ◽  
Chaidir Arif Mochtar ◽  
Aida Lydia ◽  
Nuryati Chairani Siregar ◽  
Nur Ita Margyaningsih ◽  
...  
Keyword(s):  
Low Pressure ◽  
Donor Nephrectomy ◽  
Laparoscopic Nephrectomy ◽  
Renal Tubules ◽  
Vascular Endothelial ◽  
Pressure Group ◽  
Tubular Injury ◽  
Peritubular Capillaries ◽  
Standard Pressure ◽  
Renal Tubular

Abstract Background: Laparoscopic nephrectomy is a preferable technique for living kidney donation. However, positive-pressure pneumoperitoneum may have an unfavorable effect on the remaining kidney and other distant organs due to increased systemic inflammation, endothelial vascular response and renal tubular injury. Early detection of renal injury due to increased intraabdominal pressure is needed. The aim of this study was to evaluate whether using low-pressure pneumoperitoneum reduces syndecan-1 shedding and soluble vascular endothelial growth factor receptor-2 (sVEGFR-2) expression as the early markers of vascular endothelial and renal tubular cell injury, in comparison to the standard pressure. Methods: We conducted a prospective randomized study on 44 patients undergoing laparoscopic donor nephrectomy that were allocated into standard pressure (12 mmHg) group or low-pressure (8 mmHg) group. The serial plasma interleukin-6, syndecan-1, and sVEGFR-2 were collected at baseline, intra- and postoperative, and were quantified by ELISA. We analyzed syndecan-1 and VEGFR-2 expression from renal cortex tissue by immunohistochemistry and examined the ultrastructure of renal tubules and peritubular capillaries using electron microscopy. The perioperative hemodynamic, end-tidal CO2, serum creatinine, blood urea nitrogen and urinary KIM-1 were recorded. Results: Forty-four patients were analyzed, the patients’ baseline and demographic characteristics were compared between groups. The low-pressure group showed significantly lower intra- and postoperative heart rate, intraoperative plasma IL-6 and sVEGFR-2 level compared to the standard pressure group. Plasma syndecan-1 level was lower in the low-pressure group although insignificant. Syndecan-1 expression in proximal tubules was significantly higher in the low-pressure group. The expression of VEGFR-2 in proximal, distal tubules and peritubular capillaries endothelium were significantly lower in the low-pressure group. The low-pressure group showed better morphological ultratructure of renal tubules and peritubular capillaries. Conclusion: The low-pressure pneumoperitoneum reduced the inflammatory response of plasma IL-6, the shedding of syndecan-1 and VEGFR-2 expression as the marker for renal tubular injury in laparoscopic nephrectomy. Trial registration: ClinicalTrial.gov NCT:03219398 on July 17th 2017. Keywords: Pneumoperitoneum pressure, renal resistive index, interleukin-6, syndecan-1, VEGFR-2, laparoscopic nephrectomy

Comparison of Outcome Between Low Pressure and Standard Pressure Pneumoperitoneum in Laparoscopic Living Donor Nephrectomy

2018 ◽  
Vol 24 (8) ◽  
pp. 6065-6067
Author(s):  
Nicholas Tambunan ◽  
Agus Rizal Hamid ◽  
Irfan Wahyudi ◽  
Chaidir A Mochtar
Keyword(s):  
Living Donor ◽  
Epigastric Pain ◽  
Low Pressure ◽  
Donor Nephrectomy ◽  
Adverse Outcomes ◽  
Living Donor Nephrectomy ◽  
Nonsignificant Difference ◽  
Prospective Comparative Study ◽  
Standard Pressure ◽  
Stratified Analysis

Nowadays, kidney transplantation is done through laparoscopic living donor nephrectomy performed by insufflating CO2 gas into intraperitoneum space using standard pressure (12–15 mmHg). However, it is also hypothesized that with lower pressure (8–10 mmHg) could be used for laparoscopic living donor nephrectomy related with lower postoperative pain and side effects. This was a prospective comparative study done in Department of Urology, Cipto Mangunkusumo General Hospital from November 2015 to August 2016. All subjects underwent laparoscopic living donor nephrectomy (LLDN). In this period, the subjects received a low pressure pneumoperitoneum procedure. This group was later compared randomly to a standard pressure pneumoperitoneum procedure group who underwent previous LLDN procedure. Out of 85, subjects underwent LLDN with low and standard pressure were 41 and 44, respectively. Despite nonsignificant difference of post op pain and duration of operation, the side effect in low pressure was lower than standard (p = 0.033 for epigastric pain, p = 0.024 for nausea, and p = 0.018 for vomiting). However, 22% subjects with low pressure need to be converted to standard pressure. Based on stratified analysis, the cause of conversion was higher BMI (p < 0.001). In conclusion, LLDN using low pressure pneumoperitoneum is proven to be as effective as LLDN using standard pressure pneumoperitoneum in providing good intraoperative and postoperative outcomes. Thus, this study suggests the use of low pressure pneumoperitoneum as an alternative procedure in LLDN surgeries. Further studies, however, are needed to assess the adverse outcomes of LLDN procedure using low pressure, as well as to assess the risk of conversion to standard pressure, i.e., BMI.

scholarly journals Comparison of standard and low-pressure pneumoperitoneum; reduction in frequency and intensity of post-operative shoulder pain

2019 ◽  
Vol 2 (2) ◽  
pp. 47-51
Author(s):  
Sania Waseem ◽  
Humera Naz Altaf ◽  
Sehrish Latif ◽  
Omar Shahzad Altaf ◽  
Fareeha Farooqui ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Cavity ◽  
Low Pressure ◽  
Intraabdominal Pressure ◽  
P Value ◽  
Reduced Pressure ◽  
Quasi Experimental ◽  
Group A ◽  
Standard Pressure ◽  
Group B

Laparoscopic cholecystectomy is now gold standard and depends on good exposure of the peritoneal cavity. It is achieved by insufflation of the abdominal cavity with CO2. Operating at lower intraabdominal pressure (<12 -15mmHg) has been associated with fewer pulmonary and hemodynamic complications and lesser postoperative pain. Objective: To ascertain the advantages of low pressure pneumoperitoneum over standard pressure pneumoperitoneum Methods: Our study was quasi experimental study conducted at  KRL Hospital, Islamabad over period of 3years from 2013 to 2016. SPSS version 20 was used to calculate p value.  Results: A total of 456 patients of gallstones were equally divided in two groups assigned to undergo low pressure (7-8mm of Hg) pneumoperitoneum or standard pressure (12-14mm of Hg) pneumoperitoneum laparoscopic cholecystectomy The average age of patients was 46.2+/-13.6yrs in group A compared to 43.5 +/- 12.9 in group B. There were 60 (26.3%) male and 168 (73.7%) female patients in group A compared to 53 (23.2% and 175 (76.85) in group B respectively. It was found that group A 14 (6.1%) had no pain, 26 (11.4%) had VAS between 1 – 7 and 188 (82.5%) had VAS of 8 – 10 where as in group B 164 (72.6%) patients reported no shoulder tip pain postoperatively, 42 (18.6%) had VAS of 1 – 7 and 20 (8.8%) had VAS OF 8 – 10. The difference was statistically significant (p-value = <0.001). Conclusions: reduced pressure of pneumoperitoneum to 7 – 8 mm of Hg produce lower incidence of postoperative shoulder tip pain.

scholarly journals A Comparative Study of Low Versus Standard Intraperitoneal Pressures in Gynaecological Laparoscopic Surgery

2021 ◽  
pp. 179-185
Author(s):  
Anup R. Patil ◽  
Deepika Dewani ◽  
Kalyani Mahajan ◽  
Neema Acharya ◽  
Arpita Jaiswal ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Abdominal Cavity ◽  
Laparoscopic Hysterectomy ◽  
Low Pressure ◽  
Minimal Invasive ◽  
Intraabdominal Pressure ◽  
Intraperitoneal Pressure ◽  
Organ Systems ◽  
Patient Will ◽  
Standard Pressure

Background: Minimal access surgery in contrast to open surgery has quicker recovery during the postoperative period as well as reduced scores of pain. As a result of increased pressure in the abdominal cavity, laparoscopic surgery  has many implications over a range of organ systems as well as their functioning. Laparoscopic surgery due to increased intraabdominal pressure also has many implications on various organ systems and their functioning. To overcome the consequences of increased intrabdominal pressure, a number of trials have been formulated to compare low- versus standard-pressure pneumoperitoneum. Aim: The aim of this study was to assess the effectivity of low intraperitoneal pressures v/s  standard intraperitoneal pressure during laparoscopic hysterectomies. Study Design: Experimental study  Materials and Methods: 40 cases with uncomplicated symptomatic benign uterine pathologies who were posted for laparoscopic hysterectomy were selected out of which 20-20 cases were randomized into low and standard pneumoperitoneum groups.  Results: In patients in whom low pressure pneumoperitoneum is employed are better recovered in terms of pain than standard pressure pneumoperitoneum. This means hospital stay can be shortened in low pressure pneumoperitoneum groups which will be more economical and comfortable for patients. Conclusion: Laparoscopic hysterectomy can be done at 10 mmhg with the benefits of : Optimum visualization with low pressure Reduction in post operative pain helping the patient for early ambulation so that patient will get back to routine work and normal life earlier, it is the main purpose of minimal invasive surgery.

A FOLLOW-UP STUDY - LOW-PRESSURE PNEUMOPERITONEUM COMPARED TO STANDARD PNEUMOPERITONEUM IN LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
pp. 26-27
Author(s):  
Om Prakash Pawar ◽  
Ranjana Sinha
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operative Time ◽  
Pain Syndrome ◽  
Low Pressure ◽  
Test Methods ◽  
Clinical Test ◽  
Pressure Group ◽  
Duration Of Surgery ◽  
Standard Pressure ◽  
Elective Laparoscopic Cholecystectomy

Introduction-: Post-laparoscopic pain syndrome is well conceded and characterized by abdominal and especially shoulder tip pain. It occurs frequently following laparoscopic cholecystectomy. The etiology of post-laparoscopic pain can be classied into three aspects visceral, incision, and shoulder. This study purposed to compare the frequency and strength of shoulder tip pain between low pressure (7 mmHg) and standard pressure (14 mmHg) in a prospective randomized clinical test. Methods-: One hundred forty successive patients undergoing elective laparoscopic cholecystectomy were randomized prospectively to either low or high-pressure pneumoperitoneum. The statistical analysis included mean age, weight, sex, duration of surgery, conversion rate, American Society of Anesthesiologists (ASA) grade, operative time, incidence and severity of shoulder tip pain, and post-operative hospital stay. Results -: The patient's quality was similar in the two groups except for the predominance of males in the standard-pressure group. The plan of action was successful in 68 of 70 patients in the low-pressure group. The number of analgesic injections, visual analog score, operative time, and length of post-operative days were the same in all groups. Occurence of shoulder tip pain was higher in the standard-pressure group, but not statistically signicantly so (p = 0.100) (27.9% versus 44.3%). Conclusions -: Low-pressure pneumoperitoneum tended to be better than standard-pressure pneumoperitoneum in a period of lower incidence of shoulder tip pain. Still, this difference did not reach statistical signicance following elective laparoscopic cholecystectomy

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