Efeitos da insuflação extraperitoneal de dióxido de carbono em cirurgias laparoscópicas e robóticas: revisão sistemática

Abstract

Background: Knowledge of the physiological effects associated with extraperitoneal carbon dioxide insufflation in laparoscopic surgeries, compared with those observed in the intraperitoneal approach, may contribute to the choice of the safest technique to be adopted by the surgical team in each case, when both are possible. Moreover, it enables a more predictable and safe anesthetic-surgical management, preventing complications and treating complications in a more rational and contextualized manner. Objective: To summarize information regarding the comparison of the physiological effects of extraperitoneal carbon dioxide insufflation with the intraperitoneal approach in patients undergoing laparoscopic surgeries (conventional or robotic). Method: Systematic review of experimental and quasiexperimental human studies, written in Portuguese, English or Spanish, by searching the Cochrane, Medline, Scopus, Web of Science and Lilacs databases, using MeSH and DeCS descriptors as “laparoscopy”, “carbon dioxide ”and“ peritoneal absorption”, which aims to answer the following research question: in patients undergoing laparoscopic surgery (conventional or robotic), does extraperitoneal carbon dioxide insufflation differ from the intraperitoneal approach in relation to the observed physiological effects? Results: We identified 112 bibliographic records in the searched databases, being nine studies selected for qualitative synthesis, with a total of 280 participants involved; Alterations in acid-base, hemodynamic and respiratory balance were the outcomes considered in this study. Conclusions: This review suggests that intraperitoneal carbon dioxide insufflation in laparoscopic surgery is physiologically safer than the extraperitoneal approach.