Kidney safety during surgical pneumoperitoneum: an experimental study in rats

Effect of duration of pneumoperitoneum on renal function in patients undergoing laparoscopic surgeries: a prospective observational study

This study aimed to assess the effect of pneumoperitoneum and, thereby, raised intra-abdominal pressure for different durations (≤ 1 h, 1-3 h and > 3 h) on renal function. One hundred and twenty adult patients were allocated to four groups-the Control Group A (N = 30; patients undergoing non-laparoscopic surgery) or Group B (N = 30; patients undergoing laparoscopic surgery with duration of pneumoperitoneum < 1 h) or Group C (N = 30; patients undergoing laparoscopic surgery with duration of pneumoperitoneum 1-3 h) or Group D (N = 30; patients undergoing laparoscopic surgery with duration of pneumoperitoneum > 3 h). The baseline, intraoperative (at the end of pneumoperitoneum/surgery), and postoperative (after 6 h) values of blood urea levels, creatinine clearance, and serum cystatin C were compared. The results showed that the raised IAP (10-12 mmHg) and varying durations of pneumoperitoneum (from less than 1 h to more than 3 h) did not significantly affect renal function measured in terms of change in serum cystatin levels from baseline to 6 h in postoperative period. The varying durations of pneumoperitoneum also did not significantly affect serum creatinine or blood urea levels in the postoperative period. CTRI registration: CTRI/2016/10/007334.

Scintigraphic Evaluation of the Impact of Pneumoperitoneum on Renal Blood Flow: A Rabbit Model

Background: Increased intra-abdominal pressure resulting from pneumoperitoneum can cause renal physiological changes, such as oliguria and anuria, in mammals. Although videolaparoscopic operations are common, the occurrence of renal lesions due to these procedures has not been precisely documented in the literature. The aim of this study was to evaluate the impact of pneumoperitoneum on renal blood flow using renal scintigraphy in a rabbit model. Methods: Six New Zealand male rabbits weighing 3 kg, previously anesthetized, were mechanically ventilated and underwent pneumoperitoneum. Each animal served as its own control and was analyzed in two different moments: [99mTc] diethylenetriaminepentaacetic acid (DTPA) renal blood flow evaluation in baseline conditions (T0) and 30 minutes after installation of 15 mmHg-pneumoperitoneum (T1). The animals were monitored throughout the study by capnography, oximetry, and arterial pressure median, and were euthanized at the end of the experiment. Results: The quantitative analysis of the scintigraphic images of renal uptake of the radiopharmaceutical evidence reduced renal arterial blood flow during pneumoperitoneum. Compared with baseline conditions, all animals presented a reduction of renal blood flow varying from 16% to 82%, with mean [±standard deviation] of 53% [±24%]. Conclusions: Pneumoperitoneum induces a significant reduction of the renal blood flow, as determined in this experimental method in rabbits and dynamic renal scintigraphy with [99mTc] DTPA is an adequate method to investigate this event in the experimental setting.

Oxidative damage and mitochondrial injuries differ following pneumoperitoneum pressure in rabbit models of varying degrees of hydronephrosis

The influence of intraabdominal pressure which is necessary to maintain the operating area during the surgery cannot be ignored especially on the kidneys. Many articles have reported the effect of intraabdominal pressure on normal kidneys. However, the influence of intraabdominal pressure on hydronephrosis kidneys is rarely studied. The aim of the present study was to clarify whether intraabdominal pressure tolerance is modified in various degrees of kidney hydronephrosis by evaluating oxidative damage and mitochondrial injuries. A total of 72 rabbits were randomly divided into three groups (groups N, M and S, which represented rabbits with no, mild and severe hydronephrosis, respectively). Rabbits in groups M (n=24) and S (n=24) underwent a surgical procedure inducing mild or severe hydronephrosis, respectively. Subsequently, rabbits in all groups were allocated to 4 subgroups (N0‑N3, M0‑M3 and S0‑S3) consisting of 6 rabbits each. Groups 0 to 3 were, respectively, subjected to intraabdominal pressures of 0, 5, 10 and 15 mmHg. Oxidative damage was assessed by analyzing levels of reactive oxygen species (ROS), superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GSH‑Px), catalase (CAT) and lactate (LD). Mitochondrial injuries were assessed based on mitochondrial membrane potential (MMP) alterations, mitochondrial structure and cytochrome c (cytc) protein expression, as measured by JC‑1 staining, electron microscopy and western blotting, respectively. Oxidative damage and mitochondrial injuries were noticeably exacerbated in group N and M with increased levels of ROS, MDA and LD, decreased levels of SOD, GSH‑Px, CAT and MMP, mitochondrial vacuolization and higher expression of cytc when the intraabdominal pressure reached 15 mmHg. In group S, these alterations occurred at pressures of 10 and 15 mmHg. Therefore, it was concluded that in rabbits exposed to pneumoperitoneal pressure, kidneys with severe hydronephrosis were more likely to suffer from oxidative damage and mitochondrial injuries compared with kidneys with mild hydronephrosis and normal kidneys.

The effects of prolonged CO2 insufflation on kidney function in a rat pneumoperitoneum model

INTRODUCTION

Pneumoperitoneum (PP) is known to cause ischemia in kidneys and other intra-abdominal organs because of decreased splanchnic blood flow.

AIM

We aimed to determine the degree of renal injury that occurs due to a PP and prolonged PP. We measured renal injury biomarkers and made a histopathological evaluation to estimate the degree of injury and assessed the correlation of biomarkers with histopathological findings.

MATERIAL AND METHODS

Twenty-one female Sprague Dawley rats were separated randomly into three groups. Group 1 was the control group and was given anesthesia for 3 h. In group 2, a PP was administered under anesthesia for 1 h. A pneumoperitoneum was administered under anesthesia to animals in group 3 for 3 h.

RESULTS

Pathological analysis showed a significant statistical difference between the 3 groups. In particular, neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (Cys C) levels at the 24^th h and preoperative mean urea levels showed a significant difference between the groups. The 24^th-hour NGAL level in group 3 was significantly higher than that of group 1. The preoperative Cys C level was higher in group 1 than in either group 2 or 3. Cys C was decreased significantly in group 1 and increased significantly in both groups 2 and 3.

CONCLUSIONS

The increase in NGAL and Cys C levels directly correlated with the duration of PP and intra-abdominal pressure, and they are therefore good biomarkers in diagnosing acute renal injury in the early phase. Serum creatinine level is not a good biomarker in the early phase of renal injury.

Neutrophil Gelatinase-Associated Lipocalin Levels During Pneumoperitoneum

Background and Objectives:

A temporary deterioration in renal function during pneumoperitoneum has been reported, but the extent is not known. A new marker for the early detection of renal injury, neutrophil gelatinase-associated lipocalin (NGAL), has been shown to increase in various conditions that affect renal function. This study was conducted to explore detrimental effects of pneumoperitoneum in laparoscopic surgery on renal function by studying levels of urinary NGAL (uNGAL).

Methods:

Thirty-two women scheduled to undergo laparoscopic surgery in a gynecology clinic were recruited. NGAL was measured in urine collected at the beginning (0 h) and at 2 and 24 hours after the initiation of surgery. Hemodynamic parameters were analyzed immediately after intubation and before desufflation.

Results:

Levels of uNGAL increased from 5.45 ng/mL at 0 hours to 6.35 ng/mL at 2 hours and to 6.05 ng/mL at 24 h; however, there was no significant change in uNGAL levels at the collection time points. Intraoperative oliguria was observed in all cases, and the severity increased with the duration of surgery. uNGAL levels did not correlate with the duration of surgery or pneumoperitoneum.

Conclusion:

In patients with normal renal functions, pneumoperitoneum results in transient oliguria without any early renal damage, as indicated by nonsignificant changes in uNGAL levels.

Renal Perfusion and Function during Pneumoperitoneum: A Systematic Review and Meta-Analysis of Animal Studies

Both preclinical and clinical studies indicate that raised intra-abdominal pressure (IAP) associated with pneumoperitoneum during laparoscopic surgical procedures can cause renal damage, the severity of which may be influenced by variables such as pressure level and duration. Several of these variables have been investigated in animal studies, but synthesis of all preclinical data has not been performed. This systematic review summarizes all available pre-clinical evidence on this topic, including an assessment of its quality and risk of bias. We performed meta-analysis to assess which aspects of the pneumoperitoneum determine the severity of its adverse effects. A systematic search in two databases identified 55 studies on the effect of pneumoperitoneum on renal function which met our inclusion criteria. There was high heterogeneity between the studies regarding study design, species, sex, pressure and duration of pneumoperitoneum, and type of gas used. Measures to reduce bias were poorly reported, leading to an unclear risk of bias in the majority of studies. Details on randomisation, blinding and a sample size calculation were not reported in ≥80% of the studies. Meta-analysis showed an overall increase in serum creatinine during pneumoperitoneum, and a decrease in urine output and renal blood flow. Subgroup analysis indicated that for serum creatinine, this effect differed between species. Subgroup analysis of pressure level indicated that urine output decreased as IAP level increased. No differences between types of gas were observed. Data were insufficient to reliably assess whether sex or IAP duration modulate the effect of pneumoperitoneum. Four studies assessing long-term effects indicated that serum creatinine normalized ≥24 hours after desufflation of pneumoperitoneum at 15mmHg. We conclude that harmful effects on renal function and perfusion during pneumoperitoneum appear to be robust, but evidence on long-term effects is very limited. The reliability and clinical relevance of these findings for healthy patients and patients at high risk of renal impairment remain uncertain. We emphasize the need for rigorous reporting of preclinical research methodology, which is of vital importance for clinical translation of preclinical data.

Caffeic acid phenethyl ester (CAPE) protects against acute urogenital injury following pneumoperitoneum in the rat

PURPOSE

Our aim is to determine the biochemical and histologic changes induced in the kidneys, testis and prostate on possible ischemia and reperfusion (I/R) injury caused by pneumoperitoneum (PNP) in a rat model and to evaluate the ability of protective effects of caffeic acid phenethyl ester (CAPE).

METHODS

Twenty-eight adult male Wistar albino rats were randomly divided to one of three treatment groups, with seven animals in each group. Sham, laparoscopy (L), and laparoscopy plus CAPE (L + C) group were subjected to 60 min of PNP with 15 mmHg one hour before the desufflation period. Total oxidant status (TOS) and total antioxidant status (TAS) levels were determined in kidney, testis, and prostate. Kidney and testis tissues were removed to obtain a histologic score. Also, Johnsen scoring system was used for testicular tissue analysis.

RESULTS

L group had significantly higher TOS and lower TAS levels on kidney and testis compared to the other groups. In prostate biochemical analysis, there was not any difference between groups. No difference was found between groups according to kidney and testis tissues' histologic evaluation. In evaluation of Johnsen scoring, L group showed significant lower score compared to the other two groups.

CONCLUSIONS

Increased intraabdominal pressure (IAP) had an oxidative effect on kidney and testis but not on prostate in rats. Moreover, it could affect the testicular Johnsen score. All these adverse effects of IAP on both kidney and testis could be prevented by CAPE administration.