Login to Access Video or Poster Abstract: MP52-02
Sources of Funding: None

Introduction

Laparoscopic and robotic surgeries are increasingly utilized in pediatric urology. The associated pneumoperitoneum increases intra-abdominal pressure (IAP), decreases systemic cardiac output and diminishes renal blood flow. This hypoperfusion may result in transient renal injury. The purpose of this study was to assess the short-term impact of pneumoperitoneum on renal function in children using sequential creatinine and cystatin C assays.

Methods

Prospective analysis of all children over 12 months old who underwent laparoscopic or robotic surgery at a single institution between 9/2014 and 7/2015. For each patient, blood samples were obtained in the OR immediately prior to surgery, upon transfer to the recovery room, and on the morning of POD 1 if the child stayed overnight. Intraoperative parameters, including anesthesia time (a subset of total surgical time), were recorded. The IAP was maintained at 8 mmHg for children <10 years old and at 10 mmHg for older patients. Paired t tests and linear regression were performed for statistical analysis.

Results

Over the 10-month study period, 20 children underwent laparoscopic (25%) or robotic (75%) surgery. 75% were boys. Patient and intraoperative characteristics are detailed in the table. The mean preoperative, immediate postoperative and POD 1 cystatin C values were 0.71 +/- 0.12, 0.65 +/- 0.10 and 0.60 +/- 0.12, respectively. Likewise, creatinine values were 0.35 +/-0.17, 0.41 +/- 0.18, and 0.36 +/- 0.17. There was no significant difference in cystatin C or creatinine values between the study time points. Linear regression analysis did not demonstrate an association between anesthesia time and postoperative creatinine or cystatin C values.

Conclusions

Pneumoperitoneum does not appear to affect renal function in children undergoing laparoscopic or robotic surgery. This study provides support for the use of low-pressure pneumoperitoneum and next generation valveless trocar systems. However, further investigation is warranted, given the limited sample size and relatively short duration of surgeries.

Funding

None