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Endoscopy 2011; 43(9): 808-815
DOI: 10.1055/s-0030-1256559
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Natural-orifice transluminal endoscopic surgery: low-pressure pneumoperitoneum is sufficient and is associated with an improved cardiopulmonary response (PressurePig Study)

S. von  Delius1 , 2 , A.  Schorn1 , 2 , M.  Grimm1 , 2 , A.  Schneider2 , D.  Wilhelm2 , 3 , T.  Schuster4 , M.  Stangassinger5 , H.  Feussner2 , 3 , R.  M.  Schmid1 , A.  Meining1 , 2
  • 1II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
  • 2Arbeitsgruppe für minimal-invasive Therapie und Intervention (MITI), Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
  • 3Chirurgische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
  • 4Institut für medizinische Statistik und Epidemiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
  • 5Tierärztliche Fakultät, Ludwig-Maximilians-Universität München, Munich, Germany
Further Information

Publication History

submitted 20 October 2011

accepted after revision 6 March 2011

Publication Date:
05 July 2011 (online)

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Background and aims: The aim of this randomized trial in the acute porcine model was to compare the quality of transgastric peritoneoscopy with the use of low-pressure versus standard-pressure pneumoperitoneum and to evaluate the respective associated cardiopulmonary changes.

Methods: For transgastric peritoneoscopy, carbon dioxide was insufflated via the endoscope for a constant intraperitoneal pressure of 6 mmHg or 12 mmHg in 9 pigs each. The quality of transgastric peritoneoscopy was rated on a visual analog scale (0 mm, min.; 100 mm, max.) by the endoscopist, who was blinded to the intraperitoneal pressure. The cardiac index and global end-diastolic volume index (GEDVI, reflecting preload) were measured every 3 minutes by transpulmonary thermodilution. The following were also recorded: heart rate, mean arterial pressure (MAP), systemic vascular resistance index (SVRI, reflecting afterload), peak inspiratory pressure (PIP), pH, PCO2, and PO2.

Results: The quality of transgastric peritoneoscopy with the use of low-pressure pneumoperitoneum was not inferior to that obtained using standard-pressure pneumoperitoneum (87.0 mm vs. 87.3 mm; P < 0.05). In both groups we observed a statistically significant rise in MAP and SVRI. The increase in SVRI was less pronounced during low-pressure peritoneum (P = 0.042), indicating a reduced stress response in comparison to standard-pressure peritoneum. There were no relevant differences between the groups in relation to cardiac index, GEDVI, and heart rate. An intra-abdominal pressure of 6 mmHg also led to better oxygenation (P = 0.031 for difference in PO2 between the two groups) due to lower peak inspiratory pressure (P < 0.001 for difference). There were only slight differences between the groups with regard to pH and PCO2.

Conclusions: Pneumoperitoneum of 12 – 16 mmHg is used for standard laparoscopy. For NOTES, low-pressure pneumoperitoneum is sufficient and is associated with an improved cardiopulmonary response compared to standard-pressure pneumoperitoneum.

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S. von DeliusMD 

Klinikum rechts der Isar der Technischen Universität München
II. Medizinische Klinik

Ismaninger Str. 22
81675 Munich
Germany

Fax: +49-89-41404905

Email: stefan_ruckert@yahoo.de