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

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.

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

Journal of Shifa Tameer-e-Millat University ◽

10.32593/jstmu/vol2.iss2.47 ◽

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.

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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

BMC Anesthesiology ◽

10.1186/s12871-020-0956-7 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

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.

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Prospective randomised trial of standard pressure versus low pressure laparoscopic cholecystectomy in a tertiary care hospital from Kolkata: Our experience

Asian Journal of Medical Sciences ◽

10.3126/ajms.v9i4.19780 ◽

2018 ◽

Vol 9 (4) ◽

pp. 17-22

Author(s):

Bikash Chandra Ghosh ◽

Ambar Gangopadhyay

Keyword(s):

Laparoscopic Cholecystectomy ◽

Laparoscopic Surgery ◽

Gall Stone ◽

Low Pressure ◽

Stone Disease ◽

Care Hospital ◽

Significant Difference ◽

Gall Stone Disease ◽

Standard Pressure ◽

Symptomatic Gall Stone

Background: Laparoscopic cholecystectomy (LC), the procedure of choice for symptomatic gall stone disease. An emerging trend is to perform Low pressure pnuemoperitonium laparoscopic surgery as it has additive advantages over standard pressure to avoid complications while providing adequate working space.Aims and Objectives: The current study was designed with an aim to compare the advantage of low pressure pneumoperitoneum vs standard pressure pneumoperitoneum in laparoscopic cholecystectomy.Materials and Methods: The study was conducted in the department of General Surgery in R.G.Kar Medical College from January 2014 to June 2015. A total of 52 patients with symptomatic gall stone disease were recruited, 26 patients in each group randomly. Some intraoperative and post-operative parameters were studied.Results: All the intra-operative (IO) cardio-respiratory parameters (Pulse, Mean Arterial Pressure (MAP), End tidal CO2, spO2) were recorded just before incision, 20 minutes intra-operatively and before reversal of general anesthesia (GA). The IO parameters in our study, were found to be significant only at 20 minutes IO and before reversal of GA. The post-operative (PO) parameters (Pulse, MAP, Respiratory rate, spO2) and pain by VAS score at 6 hours, 12 hours and 24 hours post-operatively were studied. In PO period, we observed significant differences at 2 hours post-operatively in all parameters except MAP. There was significant difference in pain at 6, 12 and 24 hours when compared in both groups. The shoulder tip pain (STP) and 2 hours PO nausea and vomiting were found to be significantly higher in Standard pressure Laparoscopic cholecystectomy (SPLC) compared to Low pressure Laparoscopic cholecystectomy (LPLC). The operative time, duration of hospital stay and return to normal life after surgery though had differences but it was statisticallyinsignificant.Conclusion: Low pressure laparoscopic surgery is safe with least post operative complications when performed by experienced surgeons even in patients of ASA III.Asian Journal of Medical Sciences Vol.9(4) 2018 17-22

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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

10.21203/rs.2.195/v4 ◽

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

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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

10.21203/rs.2.195/v3 ◽

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

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Clinical study of intra-abdominal pressure in the acute surgical abdomen

International Surgery Journal ◽

10.18203/2349-2902.isj20173385 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2512

Author(s):

Kumari Neelam ◽

Amit Kumar ◽

Vineet Singh ◽

Surjeet Kumar Yadav

Keyword(s):

Early Recognition ◽

Abdominal Cavity ◽

Study Groups ◽

Intraabdominal Pressure ◽

Control Group ◽

Abdominal Pressure ◽

Mean Values ◽

Organ Systems ◽

The Mean ◽

A Prospective Study

Background: Intra-abdominal pressure (IAP) is the steady-state pressure concealed within the abdominal cavity. Early recognition of rising abdominal pressure is critically important, because it allows prompt intervention which will prevent Abdominal compartment syndrome (ACS) from developing, leading to a much better prognosis for the patient. This prospective case-control study was aimed at characterisation of this entity in the commonly encountered acute surgical abdomen i.e. perforation peritonitis, intestinal obstruction and the blunt abdominal trauma. The stress was laid upon the detection of the intra-abdominal pressure in the patients and the effect of this entity upon the routinely available clinical and laboratory parameters of organ functions. The organ systems studied were the renal, cardiovascular and the pulmonary systems. The clinical outcome was also analysed.Methods: This is a prospective study conducted in Rajendra Institute of Medical Sciences, Ranchi, Jharkhand over a period of one and half year (January 2014 to June 2015). A total of 120 patients were studied, including 30 as controls. The intra-vesicular pressure was measured in all the subjects, which indirectly gives intraabdominal pressure.Results: Initial intra-abdominal pressure ranged from 0-31 cm of saline with the mean of 13.77±8.46. The mean values of the intra-abdominal pressure in the study groups i.e acute surgical cases were found to be significantly higher, as compared to that of the control group (p<0.01). Highest mortality was observed in the IAP range of >25 cm of saline (33.33%, 4 out of 12).Conclusions: Raised intraabdominal pressure significantly affects outcome and increases mortality.

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Two cases of giant peritoneal inclusion cysts requiring treatment after total laparoscopic hysterectomy

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa506 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Katsumi Kozasa ◽

Yuki Takemoto ◽

Takeshi Goto ◽

Mariya Kobayashi ◽

Hitomi Sakaguchi ◽

...

Keyword(s):

Risk Factors ◽

Abdominal Pain ◽

Laparoscopic Surgery ◽

Open Surgery ◽

Abdominal Cavity ◽

Laparoscopic Hysterectomy ◽

Total Laparoscopic Hysterectomy ◽

Strong Adhesion

Abstract Peritoneal inclusion cysts (PICs) often develop in post-operative patients. Since the incidence of adhesions is lower with laparoscopic surgery than with open surgery, PICs are less likely to occur in the former. Although post-operative adhesions or PICs rarely develop after laparoscopic surgery (such as total laparoscopic hysterectomy: TLH), we encountered two cases of giant PICs with abdominal pain after TLH. In Case 1, strong adhesion was already present when TLH was performed. Therefore, this case may have been predisposed to the development of adhesions in the abdominal cavity. However, no adhesions were observed during TLH in case 2, and there were no risk factors, such as pre-operative adhesions and endometriosis. Therefore, adhesions and PICs may develop even after TLH, and approaches need to be considered for their prevention.

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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

10.21203/rs.2.195/v6 ◽

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

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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

10.21203/rs.2.195/v5 ◽

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

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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

10.21203/rs.2.195/v2 ◽

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.

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