Stress Response and Immunologic Parameters

Changes in systemic inflammatory and antiinflammatory parameters (mainly cytokines) as well as in stress response parameters are less pronounced after laparoscopic surgery than after conventional surgery (grade A). Whether this leads to clinically relevant effects (e.g., less pain, fatigue, and complications) remains to be proven. There is no compelling clinical evidence that specific modifications of the pneumoperitoneum alter the immunological response. The influence of pneumoperitoneum on...

Introduction

When a new procedure or technology is introduced, it is expected to achieve better or at least equal results than the more traditional approaches. Classical outcomes for the evaluation of surgical procedures are usually perioperative case fatality, morbidity, recurrence rate, and long-term survival. However, from the patient's point of view, the so-called heuristic end points, such as symptom resolution, duration of convalescence, patient satisfaction and well-being, and quality of life (QoL),...

Perfusion of Intraabdominal Organs

Although in healthy subjects (ASA I and II), changes in kidney or liver perfusion (grade A) and also splanchnic perfusion (grade D) due to an intraabdominal pressure of 12-14 mmHg have no clinically relevant effects on organ function, this may not be the case in patients with already impaired perfusion. Especially in patients with impaired hepatic or renal function or atherosclerosis, intraabdominal pressure should be as low as possible to reduce microcirculatory disturbances (grade B)....

Pathophysiological Basis for the Clinical Indications Cardiovascular system

Cardiovascular effects of pneumoperitoneum occur most often during its induction, and this should be considered when initial pressure is increased for introduction of access devices. In ASA I and II patients, the hemodynamic and circulatory effects of a 12-14-mmHg capnoperitoneum are generally not clinically relevant (grade A). Due to the hemodynamic changes in ASA III and IV patients, however, invasive measurement of blood pressure or circulating volume should be considered (grade A). These...

Info

Gasless (laparolift) vs 15 mmHg C02 9 28 converted because of inade quate exposure IAP 12-15 mmHg vs laparolift Better pulmonary compliance oxigenation unchanged Technically difficult no differences in cardiopulmonary parameters and pain scores Maddox-Wing deviation higher in conventional PP group gasless plasma ren-nin activity , diuresis higher CO, group MAP , HR , pulmonary compliance , Better lung compliance No clinical benefit Less right shoulder pain, nausea, and vomiting smaller...

Pregnancy

Presupposing obstetrical consultation, laparoscopic procedures during pregnancy should be performed in the second trimester if possible (grade C). Perio-peratively, maternal end-tidal C02 concentration and arterial blood gases must be monitored to control maternal hyperventilation and to prevent fetal acidosis (grade C). For the establishment of the pneumoperitoneum the open technique should be preferred (grade C). During laparoscopy intraabdominal pressure should be kept as low as possible and...

Lung Physiology and Gas Exchange

Carbon dioxide pneumoperitoneum causes hypercapnia and respiratory acidosis. During laparoscopy, monitoring of end-tidal C02 concentration is mandatory (grade A) and minute volume of ventilation should be increased in order to maintain normocapnia. Increased intraabdominal pressure and head-down position reduce pulmonary compliance and lead to ventilationperfusion mismatch (grade A). In patients with normal lung function, these intraoperative respiratory changes are usually not clinically...

Appendix Information on Recommended Measures Child Health Questionnaire

The CHQ, designed to measure the physical and psychological well-being of children 5 years or older, has several forms related to the age of the child and who completes the questionnaire 67 , There are three parent forms and a form to be completed by children aged 10 years or older 87 items , The questionnaires tap 14 concepts related to health and well-being, Item responses are on 4- to 6-point scales, Scale scores are transformed to range from 0 to 100, Higher scores reflect better health,...