HEMODYNAMIC CHANGES DURING GASEOUS AND GASLESS LAPAROSCOPIC CHOLECYSTECTOMY
MUHİTTİN ALKIŞ, ENVER OKAN HAMAMCI, NİLÜFER ERVERDİ, HASAN BESİM, ATİLA KORKMAZ
Numune Hastanesi Eğitim ve Araştırma Merkezi, 6. Cerrahi Kliniği, ANKARA
The aim of the present study is to investigate the hemodynamic effects of pneumoperitoneum and the comparison of gasless and gaseous laparoscopy in the hemodynamical basis. The main disadvantage of the gaseous laparoscopic technique is the C02 insufflation and the elevation of intraabdominal pressure. Alternatives to gaseous laparoscopic surgery are being investigated to prevent these hazardous effects of pneumoperitoneum. In 31 patients with cholelithiasis, 20 gaseous and 11 gasless laparoscopic cholecystectomies were performed. Mean arterial pressure (MAP),heart rate (HR), end diastolic index (EDI), systemic vascular resistance index (SVRI), cardiac index (Cl),ejection fraction (EF) and stroke index(SI) values were measured and compared. In the gaseous group statistically significant changes were detected in MAP, SVRI, Cl, EF and SI values. In the gasless group the minimal changes were in the DSI, SVRI and SI values. SVRI, EDI and Cl differences were statistically significant when compared between the two groups. In conclusion hemodynamic changes in the gaseous laparoscopic surgery is due to elevated intraabdominal pressure and one can be saved from these hazardous effects by performing gasless technique in selected cases.
Keywords: INTRAABDOMINAL PRESSURE, LAPAROSCOPY, HEMODYNAMIC PARAMETERS