Effects of Retroperitoneal or Transperitoneal Pneumoperitoneum on Inferior Vena Cava Hemodynamics and Cardiopulmonary Function: A Prospective Real-Time Comparison

To evaluate the effects of CO pneumoperitoneum on venous hemodynamics and cardiopulmonary function during transperitoneal or retroperitoneal laparoscopic surgery. A single-institution prospective study. Forty-three patients with renal-cell carcinoma undergoing retroperitoneal (22) or transperitoneal (21) laparoscopic partial nephrectomy were enrolled. Hemodynamic functions were monitored by minimally invasive FloTrac/Vigileo system. Transesophageal echocardiography was used to measure the diameter and blood flow of the inferior vena cava (IVC). Measured parameters were recorded at baseline, 10, 30, 60 minutes following insufflation to 14 mm Hg and 10 minutes following desufflation. For hemodynamic changes in the transperitoneal laparoscopic surgery (TPL) and retroperitoneal laparoscopic surgery (RPL), transperitoneal CO insufflation resulted in a rapid parallel increase in central intravenous pressure (CVP), peak airway pressure (AWP), and IVC blood flow velocity after the first 30 minutes of pneumoperitoneum (