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Carbon dioxide absorption during retroperitoneoscopic adrenalectomy: comparison between monolateral and synchronous bilateral approaches

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Abstract

Synchronous posterior retroperitoneoscopic bilateral adrenalectomy (PR-BilA) is a novel technique proposed for the definitive cure of hypercortisolism when a surgical approach is indicated. The aim of the present prospective cohort study was to compare the carbon dioxide (CO2) absorption in patients undergoing PR-BilA with those undergoing single posterior retroperitoneoscopic adrenalectomy (PRA). Twenty-nine patients undergoing PR-BilA or PRA were consecutively enrolled. Anaesthesia was standardised. In both groups, CO2 elimination (VCO2), CO2 dissolved in arterial blood (PaCO2), end-tidal CO2 (EtCO2), and volume per minute (VM) were measured at the following time points: after anaesthesia induction and before CO2 insufflation (T1), 5 min after CO2 insufflation (T2), at the time of maximum VCO2 (T3), and at desufflation (T4). VCO2 was continuously measured using a metabolic monitor. ANOVA for repeated measures was used for statistical analysis. With respect to VCO2, a significant group × time interaction was found (p = 0.03). Post hoc analysis revealed that VCO2 was significantly increased at T4 compared with T1 in both groups (p = 0.02 and p = 0.0001 in the PRA and PR-BilA groups, respectively). Regarding PaCO2, ANOVA analysis showed a significant group effect (p = 0.01), with higher values in the PR-BilA group. EtCO2 and VM did not differ between the two groups. We found that the CO2 absorption was increased in both groups at the end of surgery, in the presence of a higher trend in PaCO2 values during PR-BilA. Therefore, PR-BilA may be considered a safe surgical approach with respect to CO2 absorption, when a mild degree of hypercapnia may be accepted.

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References

  1. Walz MK, Alesina PF, Wenger FA et al (2006) Posterior retroperitoneoscopic adrenalectomy: results of 560 procedures in 520 patients. Surgery 140:943–948. https://doi.org/10.1016/j.surg.2006.07.039

    Article  PubMed  Google Scholar 

  2. Wong A, Eloy JA, Jk Liu (2015) The role of bilateral adrenalectomy in the treatment of refractory Cushing’s disease. Neurosurg Focus 38:E9. https://doi.org/10.3171/2014.10.FOCUS14684

    Article  PubMed  Google Scholar 

  3. Maccora D, Walls GV, Sadler GP, Mihai R (2017) Bilateral adrenalectomy: a review of 10 years’ experience. Ann R Coll Surg Engl 99:119–122. https://doi.org/10.1308/rcsann.2016.0266

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Raffaelli M, Brunaud L, De Crea C et al (2014) Synchronous bilateral adrenalectomy for Cushing’s syndrome: laparoscopic versus posterior retroperorg/itoneoscopic versus robotic approach. World J Surg 38:709–715. https://doi.org/10.1007/s00268-013-2326-9

    Article  PubMed  Google Scholar 

  5. Miccoli P, Materazzi G, Brauckhoff M, Ambrosini CE, Miccoli M, Dralle H (2011) No outcome differences between a laparoscopic and retroperitoneoscopic approach in synchronous bilateral adrenal surgery. Word J Surg 35:2698–2702. https://doi.org/10.1007/s00268-011-1294-1

    Article  Google Scholar 

  6. Lombardi CP, Raffaelli M, de Crea C, Bellantone R, Fusco A, Bianchi A, Pontecorvi A, de Marinis L (2011) ACTH-dependent Cushing syndrome: The potential benefits of simultaneous bilateral posterior retroperitoneoscopic adrenalectomy. Surgery 149:299–300. https://doi.org/10.1016/j.surg.2010.06.005

    Article  PubMed  Google Scholar 

  7. De Crea C, Raffaelli M, D’Amato G, Princi P, Gallucci P, Bellantone R, Lombardi CP (2017) Retroperitoneoscopic adrenalectomy: tips and tricks. Updates Surg 69:267–270. https://doi.org/10.1007/s13304-017-0469-1

    Article  PubMed  Google Scholar 

  8. Vestbo J, Hurd SS, Agusti AG et al (2013) Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease, GOLD executive summary. Am J Respir Crit Care Med 187:347–365. https://doi.org/10.1164/rccm.201204-0596PP

    Article  CAS  PubMed  Google Scholar 

  9. Tissot S, Delafosse B, Bertrand O, Bouffard Y, Viale JP, Annat G (1995) Clinical validation of the Deltatrac monitoring system in mechanically ventilated patients. Intensive Care Med 21:149–153

    Article  CAS  PubMed  Google Scholar 

  10. Streich B, Decilliot F, Perney C, Duvaldestin P (2003) Increased carbon dioxide absorption during retroperitoneal laparoscopy. Br J Anaesth 91:793–796

    Article  CAS  PubMed  Google Scholar 

  11. Mullet CE, Viale JP, Sagnard PE et al (1993) Pulmonary CO2 elimination during surgical procedures using intra- or extraperitoneal CO2 insufflation. Anesth Analg 76:622–626

    Article  Google Scholar 

  12. Siperstein AE, Berber E, Engle KL, Duh QY, Clark OH (2000) Laparoscopic posterior adrenalectomy: technical considerations. Arch Surg 135:967–971

    Article  CAS  PubMed  Google Scholar 

  13. Zhu YF, Meng FM (2015) Effect of retroperitoneal lavage with normal saline containing adrenaline on carbon dioxide absorption in patients undergoing retroperitoneal laparoscopic surgery. J Laparoendosc Adv Surg Tech A 25:903–907. https://doi.org/10.1089/lap.2015.0215

    Article  PubMed  Google Scholar 

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Correspondence to Paola Aceto.

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Informed consent was obtained from all the patients included in the study.

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Perilli, V., Aceto, P., Punzo, G. et al. Carbon dioxide absorption during retroperitoneoscopic adrenalectomy: comparison between monolateral and synchronous bilateral approaches. Updates Surg 71, 543–547 (2019). https://doi.org/10.1007/s13304-018-00610-3

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  • DOI: https://doi.org/10.1007/s13304-018-00610-3

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