| Renal implications of pneumoperitoneum in laparoscopic surgery: mechanisms, risk factors, and preventive strategies |
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Gianluca Villa1,2, Marco Fiorentino3, Eleonora Cappellini1, Sergio Lassola4, Silvia De Rosa4,5 |
1Department of Health Sciences, Anesthesiology Intensive Care and Pain Medicine, University of Florence, Florence, Italy
2Department of Anesthesia and Intensive Care, Oncological Anesthesia and Intensive Care, AOU Careggi, Florence, Italy
3Department of Emergency and Organ Transplants, Nephrology, University of Bari, Piazza Giulio Cesare, 70124 Bari, Italy
4Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Italy
5Centre for Medical Sciences - CISMed, University of Trento, Via S. Maria Maddalena 1, 38122 Trento, Italy |
Corresponding author:
Silvia De Rosa, Tel: +39 3933098583,
Email: derosa.silvia@ymail.com; silvia.derosa@unitn.it
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Received: 8 February 2024 • Revised: 9 April 2024 • Accepted: 12 April 2024 |
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| Abstract |
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Pneumoperitoneum, which is established for laparoscopic surgery, has systemic implications on the renal system and may contribute to acute kidney injury or postoperative renal dysfunction. Specifically, when the pressure exceeds 10 mmHg, pneumoperitoneum decreases renal blood flow, leading to renal dysfunction and temporary oliguria. The renal effects of pneumoperitoneum stem from both the direct effects of increased intra-abdominal pressure and indirect factors such as carbon dioxide absorption, neuroendocrine influences, and tissue damage resulting from oxidative stress. While pneumoperitoneum can exacerbate renal dysfunction in patients with pre-existing kidney issues, preserving the function of the remaining kidney is crucial in certain procedures such as laparoscopic live donor nephrectomy. However, available evidence on the effects of pneumoperitoneum on renal function is limited and of moderate quality. This review focuses on exploring the pathophysiological hypotheses underlying kidney damage, mechanisms leading to oliguria and kidney damage, and fluid management strategies for surgical patients during pneumoperitoneum. |
| Key Words:
Acute kidney injury; Biomarkers; Elective surgical procedure; Pneumoperitoneum; Renal plasma flow; Robot-assisted surgery |
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