Low‐pressure pneumoperitoneum during laparoscopic donor nephrectomy to optimize live donors’ comfort

Abstract

Nowadays, laparoscopic donor nephrectomy (LDN) has become the gold standard to procure live donor kidneys. As the relationship between donor and recipient loosens, it becomes of even greater importance to optimize safety and comfort of the surgical procedure. Low-pressure pneumoperitoneum has been shown to reduce pain scores after laparoscopic cholecystectomy. Live kidney donors may also benefit from the use of low pressure during LDN. To evaluate feasibility and efficacy to reduce post-operative pain, we performed a randomized blinded study. Twenty donors were randomly assigned to standard (14 mmHg) or low (7 mmHg) pressure during LDN. One conversion from low to standard pressure was indicated by protocol due to lack of progression. Intention-to-treat analysis showed that low pressure resulted in a significantly longer skin-to-skin time (149 ± 86 vs. 111 ± 19 min), higher urine output during pneumoperitoneum (23 ± 35 vs. 11 ± 20 mL/h), lower cumulative overall pain score after 72 h (9.4 ± 3.2 vs. 13.5 ± 4.5), lower deep intra-abdominal pain score (11 ± 3.3 vs. 7.5 ± 3.1), and a lower cumulative overall referred pain score (1.8 ± 1.9 vs. 4.2 ± 3). Donor serum creatinine levels, complications, and quality of life dimensions were not significantly different. Our data show that low-pressure pneumoperitoneum during LDN is feasible and may contribute to increase live donors' comfort during the early post-operative phase.

Effectiveness of deep versus moderate muscle relaxation during laparoscopic donor nephrectomy in enhancing postoperative recovery: study protocol for a randomized controlled study

“…In a previous pilot study by our group, low-pressure pneumoperitoneum (7 mmHg) during laparoscopic donor nephrectomy reduced postoperative pain scores, compared with standard pressure pneumoperitoneum [7]. This finding is in agreement with a meta-analysis showing that the use of low-pressure pneumoperitoneum provides a clinically relevant reduction in postoperative pain scores after laparoscopic surgery [8].…”

Components of pain assessment after laparoscopic donor nephrectomy

“…8 Strategies to improve the management of the referred shoulder pain component are limited; however, a recent study by our group showed that the use of low-pressure pneumoperitoneum (7 mmHg) was feasible and significantly reduced referred shoulder pain after laparoscopic donor nephrectomy. 9 Limitations of this study are mainly related to its exploratory design without a sample size calculation, i.e. this study was not adequately powered to identify risk factors for post-operative pain in a multivariate analysis.…”

Effect of pneumoperitoneum on the recovery from intense neuromuscular blockade by rocuronium in healthy patients undergoing laparoscopic surgery

“…Considering all of these facts, we thought that our results may be by the mechanical effect of pneumoperitoneum on intraabdominal organ and not by the irreversible impairment of liver function. Nowadays, intraabdominal pressure for induced pneumoperitoneum often is set as low as 7-8 mmHg because it guarantees advantage in postoperative complication such as overall postoperative pain, preservation of pulmonary function, or at least there are no differences postoperative outcome [22,23]. But this low pressure method has some drawbacks.…”