Respiratory Mechanics During Laparoscopic Cholecystectomy

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Abstract
The abdominal wall lift (AWL) has been proposed for laparoscopic cholecystectomy to reduce hemodynamic effects caused by carbon dioxide (CO,) and high intra- abdominal pressures (IAP). Data concerning effects of AWL on respiratory mechanics are scant. We therefore used a noninvasive method to evaluate whether the AWL could offset these effects. The PETCO,, airflow, and airway pressure were continuously measured in nine patients undergoing laparoscopic cholecystec- tomy using an AWL with minimal CO, insufflation. We used a least-squares method to calculate maximal air- way pressure (Pmax), elastance (Ers), and resistances (Rrs) of the respiratory system. After CO, insufflation, the initiation of AWL resulted in a significantly de- creased IAP (from 13 to 6 mm Hg; P < 0.001) and Rrs (from 20.6 to 17.8 cm H,O 3 L-l * s-'; P = 0.029), whereas Ers was partly modified (34.0 to 33.3 cm H,O/L; not significantly different). With AWL, we