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Physiology of Minimally Invasive Surgery Versus Open Surgery

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Abstract

Endoscopic and minimally invasive surgery (MIS) in pediatric urology affords many benefits when compared to open surgery but also introduces unique physiologic considerations. The surgical team must be aware of the physiologic changes associated with these approaches in order to avoid making MIS detrimental. The knowledge presented in this chapter should bring the anesthetist and the MIS surgeon together to uphold the success of these procedures and ultimately improve the care of children in this setting.

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Abbreviations

CBF:

Cerebral blood flow

CO:

Cardiac output

CO2 :

Carbon dioxide

ETCO2 :

End tidal CO2

GFR:

Glomerular filtration rate

HR:

Heart rate

IAP:

Intra-abdominal pressure

ICP:

Intracranial pressure

MAP:

Mean arterial pressure

MIS:

Minimally invasive surgery

PIP:

Peak inspiratory pressure

SV:

Stroke volume

SVR:

Systemic vascular resistance

References

  1. Ahmed A. Laparoscopic surgery in children–anaesthetic considerations. J Pak Med Assoc. 2006;56(2):75–9.

    PubMed  Google Scholar 

  2. Bannister CF, Brosius KK, Wulkan M. The effect of insufflation pressure on pulmonary mechanics in infants during laparoscopic surgical procedures. Paediatr Anaesth. 2003;13(9):785–9.

    Article  PubMed  Google Scholar 

  3. Powers CJ, Levitt MA, Tantoco J, Rossman J, Sarpel U, Brisseau G, et al. The respiratory advantage of laparoscopic Nissen fundoplication. J Pediatr Surg. 2003;38(6):886–91.

    Article  PubMed  Google Scholar 

  4. Rawashdeh YF, Olsen LH, Jørgensen TM. Physiology of paediatric genitourinary laparoscopy. Totowa: Humana Press; 2009. p. 23–41.

    Google Scholar 

  5. Farhat W, Dave S. Physiological effects of pediatric urological laparoscopic surgery. Indian J Urol. 2006;22(4):304.

    Article  Google Scholar 

  6. Gentili A, Iannettone CM, Pigna A, Landuzzi V, Lima M, Baroncini S. Cardiocirculatory changes during videolaparoscopy in children: an echocardiographic study. Paediatr Anaesth. 2000;10(4):399–406.

    Article  CAS  PubMed  Google Scholar 

  7. Wedgewood J, Doyle E. Anaesthesia and laparoscopic surgery in children. Pediatr Anesth. 2001;11(4):391–9.

    Article  CAS  Google Scholar 

  8. Kalfa N, Allal H, Raux O, Lopez M, Forgues D, Guibal M-P, et al. Tolerance of laparoscopy and thoracoscopy in neonates. Pediatrics. 2005;116(6):e785–91.

    Article  PubMed  Google Scholar 

  9. Metzelder ML, Kuebler JF, Huber D, Vieten G, Suempelmann R, Ure BM, et al. Cardiovascular responses to prolonged carbon dioxide pneumoperitoneum in neonatal versus adolescent pigs. Surg Endosc. 2010;24(3):670–4.

    Article  CAS  PubMed  Google Scholar 

  10. de Waal EEC, de Vries JW, Kruitwagen CLJJ, Kalkman CJ. The effects of low-pressure carbon dioxide pneumoperitoneum on cerebral oxygenation and cerebral blood volume in children. Anesth Analg. 2002;94(3):500–5. table of contents.

    Article  PubMed  Google Scholar 

  11. McHoney M, Corizia L, Eaton S, Kiely EM, Drake DP, Tan HL, et al. Carbon dioxide elimination during laparoscopy in children is age dependent. J Pediatr Surg. 2003;38(1):105–10. discussion 105–10.

    Article  PubMed  Google Scholar 

  12. Hsing CH, Hseu SS, Tsai SK, Chu CC. The physiological effect of CO2 pneumoperitoneum in pediatric laparoscopy. – Abstract – Europe PubMed Central. Acta Anaesthesiol Sin. 1995;33(1):1–6.

    Google Scholar 

  13. Truchon R. Anaesthetic considerations for laparoscopic surgery in neonates and infants: a practical review. Best Pract Res Clin Anaesthesiol. 2004;18(2):343–55.

    Article  PubMed  Google Scholar 

  14. Baird JE, Granger R, Klein R, Warriner CB, Phang PT. The effects of retroperitoneal carbon dioxide insufflation on hemodynamics and arterial carbon dioxide. Am J Surg. 1999;177(2):164–6.

    Article  CAS  PubMed  Google Scholar 

  15. Wolf Jr JS, Carrier S, Stoller ML. Intraperitoneal versus extraperitoneal insufflation of carbon dioxide as for laparoscopy. J Endourol. 1995;9(1):63–6.

    Article  PubMed  Google Scholar 

  16. Wolf JS, Monk TG, McDougall EM, McClennan BL, Clayman RV. The extraperitoneal approach and subcutaneous emphysema are associated with greater absorption of carbon dioxide during laparoscopic renal surgery. J Urol. 1995;154(3):959–63.

    Article  PubMed  Google Scholar 

  17. Streich B, Decailliot F, Perney C, Duvaldestin P. Increased carbon dioxide absorption during retroperitoneal laparoscopy. Br J Anaesth. 2003;91(6):793–6.

    Article  CAS  PubMed  Google Scholar 

  18. Lorenzo AJ, Karsli C, Halachmi S, Dolci M, Luginbuehl I, Bissonnette B, et al. Hemodynamic and respiratory effects of pediatric urological retroperitoneal laparoscopic surgery: a prospective study. J Urol. 2006;175(4):1461–5.

    Article  PubMed  Google Scholar 

  19. Karsli C, El-Hout Y, Lorenzo AJ, Langer JC, Bägli DJ, Pippi Salle JL, et al. Physiological changes in transperitoneal versus retroperitoneal laparoscopy in children: a prospective analysis. J Urol. 2011;186(4 Suppl):1649–52.

    Article  PubMed  Google Scholar 

  20. Huettemann E, Terborg C, Sakka SG, Petrat G, Schier F, Reinhart K. Preserved CO(2) reactivity and increase in middle cerebral arterial blood flow velocity during laparoscopic surgery in children. Anesth Analg. 2002;94(2):255–8. table of contents.

    PubMed  Google Scholar 

  21. Fujimoto T, Segawa O, Lane GJ, Esaki S, Miyano T. Laparoscopic surgery in newborn infants. Surg Endosc. 1999;13(8):773–7.

    Article  CAS  PubMed  Google Scholar 

  22. Wolf JS, Stoller ML. Laparoscopic Surgery. In: Tanagho EA, McAninch JW (eds) Smith’s General Urology. McGraw Hill Professional; 2007. 17 ed., p. 135–7.

    Google Scholar 

  23. de Waal EE. The hemodynamic effects of pneumoperitoneum during laparoscopic surgery in healthy infants: assessment by continuous esophageal aortic blood flow echo Doppler. Anesth Analg. 1999;88(2):468–9.

    PubMed  Google Scholar 

  24. Josephs LG, Este-McDonald JR, Birkett DH, Hirsch EF. Diagnostic laparoscopy increases intracranial pressure. J Trauma. 1994;36(6):815–8. discussion 818–9.

    Article  CAS  PubMed  Google Scholar 

  25. Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ. Effects of increased intra-abdominal pressure upon intracranial and cerebral perfusion pressure before and after volume expansion. J Trauma. 1996;40(6):936–41. discussion 941–3.

    Article  CAS  PubMed  Google Scholar 

  26. Gaskill SJ, Cossman RM, Hickman MS. Laparoscopic surgery in a patient with a ventriculoperitoneal shunt: a new technique. Pediatr Neurosci. 1998;28(2):106–7.

    Article  CAS  Google Scholar 

  27. Baskin JJ, Vishteh AG, Wesche DE, Rekate HL, Carrion CA. Ventriculoperitoneal shunt failure as a complication of laparoscopic surgery. JSLS. 1998;2(2):177–80.

    CAS  PubMed Central  PubMed  Google Scholar 

  28. Ravaoherisoa J, Meyer P, Afriat R, Meyer Y, Sauvanet E, Tricot A, et al. Laparoscopic surgery in a patient with ventriculoperitoneal shunt: monitoring of shunt function with transcranial Doppler. Br J Anaesth. 2004;92(3):434–7.

    Article  CAS  PubMed  Google Scholar 

  29. Marchetti P, Razmaria A, Zagaja GP, Gundeti MS. Management of the ventriculo-peritoneal shunt in pediatric patients during robot-assisted laparoscopic urologic procedures. J Endourol. 2011;25(2):225–9.

    Article  PubMed  Google Scholar 

  30. Uzzo RG, Bilsky M, Mininberg DT, Poppas DP. Laparoscopic surgery in children with ventriculoperitoneal shunts: effect of pneumoperitoneum on intracranial pressure – preliminary experience. Urology. 1997;49(5):753–7.

    Article  CAS  PubMed  Google Scholar 

  31. Jackman SV, Weingart JD, Kinsman SL, Docimo SG. Laparoscopic surgery in patients with ventriculoperitoneal shunts: safety and monitoring. J Urol. 2000;164(4):1352–4.

    Article  CAS  PubMed  Google Scholar 

  32. Fraser JD, Aguayo P, Sharp SW, Holcomb III GW, Ostlie DJ, St Peter SD. The safety of laparoscopy in pediatric patients with ventriculoperitoneal shunts. J Laparoendosc Adv Surg Tech A. 2009;19(5):675–8.

    Article  PubMed  Google Scholar 

  33. Neale ML, Falk GL. In vitro assessment of back pressure on ventriculoperitoneal shunt valves. Is laparoscopy safe? Surg Endosc. 1999;13(5):512–5.

    Article  CAS  PubMed  Google Scholar 

  34. Matsumoto T, Endo Y, Uchida H, Kusumoto T, Muto Y, Kitano S. An examination of safety on laparoscopic surgery in patients with ventriculoperitoneal shunt by a CO2 reflux experiment. J Laparoendosc Adv Surg Tech A. 2010;20(3):231–4.

    Article  PubMed  Google Scholar 

  35. Tobias JD, Holcomb GW, Brock JW, Deshpande JK, Lowe S, Morgan WM. Cardiorespiratory changes in children during laparoscopy. J Pediatr Surg. 1995;30(1):33–6.

    Article  CAS  PubMed  Google Scholar 

  36. Collure DWD, Bumpers HL, Luchette FA, Weaver WL, Hoover EL. Laparoscopic cholecystectomy in patients with ventriculoperitoneal (VP) shunts. Surg Endosc. 1995;9(4):409–10.

    CAS  PubMed  Google Scholar 

  37. Walker DH, Langer JC. Laparoscopic surgery in children with ventriculoperitoneal shunts. J Pediatr Surg. 2000;35(7):1104–5.

    Article  CAS  PubMed  Google Scholar 

  38. Kimura T, Nakajima K, Wasa M, Yagi M, Kawahara H, Soh H, et al. Successful laparoscopic fundoplication in children with ventriculoperitoneal shunts. Surg Endosc. 2002;16(1):215b.

    Article  Google Scholar 

  39. Safran DB, Orlando R. Physiologic effects of pneumoperitoneum. Am J Surg. 1994;167(2):281–6.

    Article  CAS  PubMed  Google Scholar 

  40. Halachmi S, El-Ghoneimi A, Bissonnette B, Zaarour C, Bägli DJ, McLorie GA, et al. Hemodynamic and respiratory effect of pediatric urological laparoscopic surgery: a retrospective study. J Urol. 2003;170(4 Pt 2):1651–4. discussion 1654.

    Article  PubMed  Google Scholar 

  41. Gueugniaud PY, Abisseror M, Moussa M, Godard J, Foussat C, Petit P, et al. The hemodynamic effects of pneumoperitoneum during laparoscopic surgery in healthy infants: assessment by continuous esophageal aortic blood flow echo-Doppler. Anesth Analg. 1998;86(2):290–3.

    CAS  PubMed  Google Scholar 

  42. Aldridge RD, MacKinlay GA, Aldridge RB. Physiological effects of pneumoperitoneum in laparoscopic pyloromyotomy. J Laparoendosc Adv Surg Tech A. 2006;16(2):156–8.

    Article  CAS  PubMed  Google Scholar 

  43. Terrier G. Anaesthesia for laparoscopic procedures in infants and children: indications, intra- and post-operative management, prevention and treatment of complications. Curr Opin Anaesthesiol. 1999;12(3):311–4.

    Article  CAS  PubMed  Google Scholar 

  44. Sakka SG, Huettemann E, Petrat G, Meier-Hellmann A, Schier F, Reinhart K. Transoesophageal echocardiographic assessment of haemodynamic changes during laparoscopic herniorrhaphy in small children. Br J Anaesth. 2000;84(3):330–4.

    Article  CAS  PubMed  Google Scholar 

  45. Kirsch AJ, Hensle TW, Chang DT, Kayton ML, Olsson CA, Sawczuk IS. Renal effects of CO2 insufflation: oliguria and acute renal dysfunction in a rat pneumoperitoneum model. Urology. 1994;43(4):453–9.

    Article  CAS  PubMed  Google Scholar 

  46. McDougall EM, Monk TG, Wolf JS Jr, Hicks M. The effect of prolonged pneumoperitoneum on renal function in an animal model. – Abstract – Europe PubMed Central. J Am Coll Surg. 1996;182(4):317–28.

    Google Scholar 

  47. Razvi HA, Fields D, Vargas JC, Vaughan ED, Vukasin A, Sosa RE. Oliguria during laparoscopic surgery: evidence for direct renal parenchymal compression as an etiologic factor. J Endourol. 1996;10(1):1–4.

    Article  CAS  PubMed  Google Scholar 

  48. Gómez Dammeier BH, Karanik E, Glüer S, Jesch NK, Kübler J, Latta K, et al. Anuria during pneumoperitoneum in infants and children: a prospective study. J Pediatr Surg. 2005;40(9):1454–8.

    Article  PubMed  Google Scholar 

  49. Wallis MC, Khoury AE, Lorenzo AJ, Pippi Salle JL, Bägli DJ, Farhat WA. Outcome analysis of retroperitoneal laparoscopic heminephrectomy in children. J Urol. 2006;175(6):2277–80. discussion 2280–2.

    Article  PubMed  Google Scholar 

  50. Manner T, Aantaa R, Alanen M. Lung compliance during laparoscopic surgery in paediatric patients. Paediatr Anaesth. 1998;8(1):25–9.

    Article  CAS  PubMed  Google Scholar 

  51. Yeung CK. Complications of laparoscopic and retroperitoneoscopic renal surgery in infants and children. Pediatr Endosurg Innov Tech. 2003;7(1):19–26.

    Article  Google Scholar 

  52. Muth CM, Shank ES. Gas embolism. N Engl J Med. 2000;342(7):476–82.

    Article  CAS  PubMed  Google Scholar 

  53. Zhao LC, Han JS, Loeb S, Tenggardjaja C, Rubenstein RA, Smith ND, et al. Thoracic complications of urologic laparoscopy: correlation between radiographic findings and clinical manifestations. J Endourol. 2008;22(4):607–14.

    Article  PubMed  Google Scholar 

  54. Abreu SC, Sharp DS, Ramani AP, Steinberg AP, Ng CS, Desai MM, et al. Thoracic complications during urological laparoscopy. J Urol. 2004;171(4):1451–5.

    Article  PubMed  Google Scholar 

  55. Waterman BJ, Robinson BC, Snow BW, Cartwright PC, Hamilton BD, Grasso M. Pneumothorax in pediatric patients after urological laparoscopic surgery: experience with 4 patients. J Urol. 2004;171(3):1256–8. discussion1258–9.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pediatric Urology, The Hospital for Sick Children, Toronto, ON, Canada

    Niki Kanaroglou BA Sc, MD, FRCSC

  2. Department of Surgery, Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada

    Walid A. Farhat MD

Authors
  1. Niki Kanaroglou BA Sc, MD, FRCSC
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  2. Walid A. Farhat MD
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Corresponding author

Correspondence to Niki Kanaroglou BA Sc, MD, FRCSC .

Editor information

Editors and Affiliations

  1. Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom

    Prasad P. Godbole

  2. Hospital for Sick Children, Toronto, Ontario, Canada

    Martin A. Koyle

  3. The Children's Hospital, Aurora, Colorado, USA

    Duncan T. Wilcox

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Kanaroglou, N., Farhat, W.A. (2014). Physiology of Minimally Invasive Surgery Versus Open Surgery. In: Godbole, P., Koyle, M., Wilcox, D. (eds) Pediatric Endourology Techniques. Springer, London. https://doi.org/10.1007/978-1-4471-5394-8_4

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  • DOI: https://doi.org/10.1007/978-1-4471-5394-8_4

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  • Online ISBN: 978-1-4471-5394-8

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