Endoscopy 2002; 34(8): 643-650
DOI: 10.1055/s-2002-33252
Original Article
© Georg Thieme Verlag Stuttgart · New York

Changes in Hemodynamics and Autonomic Nervous Activity in Patients Undergoing Laparoscopic Cholecystectomy: Differences Between the Pneumoperitoneum and Abdominal Wall-Lifting Method

N.  Uemura 1 , M.  Nomura 2 , S.  Inoue 1 , J.  Endo 1 , S.  Kishi 1 , K.  Saito 2 , S.  Ito 2 , Y.  Nakaya 3
  • 1Department of Gastroenterology, National Kochi Hospital, Kochi, Japan
  • 2Second Department of Internal Medicine, School of Medicine, University of Tokushima, Tokushima, Japan
  • 3Department of Nutrition, School of Medicine, University of Tokushima, Tokushima, Japan
Further Information

Publication History

Submitted 6 September 2001

Accepted after Revision 15 April 2002

Publication Date:
12 August 2002 (online)

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Background and Study Aims: Intraoperative changes in circulatory hemodynamics and autonomic nervous activity were evaluated in 33 patients with cholelithiasis who underwent laparoscopic cholecystectomy.
Patients and Methods: Of these patients, 18 were treated using a pneumoperitoneum (group G) and 15 using the abdominal wall-lifting method (group WL). Their ECG, blood pressure, arterial oxygen saturation, and expiratory carbon dioxide partial pressure were monitored. Autonomic nervous function was evaluated by spectral analysis of the heart rate.
Results: Mean blood pressure increased significantly in group G during surgery, but did not vary in group WL during any stage of surgery. The high-frequency (HF) power, an index of parasympathetic activity, decreased significantly in group G after pneumoperitoneum. However, the HF power did not decrease significantly in group WL. The LF/HF ratio, an index of sympathetic activity, increased significantly in group G after pneumoperitoneum, but did not vary in group WL. In addition, the incidence of ventricular or supraventricular arrhythmias and the severity of the arrhythmias as determined by Lown’s classification were higher in group G than in group WL. These findings suggest that intraoperative changes in autonomic nervous activity, due to increased intra-abdominal pressure, were smaller in patients undergoing laparoscopic cholecystectomy using the abdominal wall-lifting method than in those undergoing laparoscopic cholecystectomy using pneumoperitoneum. The results also demonstrated that hemodynamic changes were smaller in patients undergoing the abdominal wall-lifting method than in those undergoing pneumoperitoneum.
Conclusions: It was concluded that hemodynamics should be carefully monitored during pneumoperitoneum, and that the abdominal wall-lifting approach in laparoscopic cholecystectomy is a method worthy of consideration for elderly patients or those with cardiopulmonary complications.