Renal physiology - Laparoscopic considerations

The pneumoperitoneum used for laparoscopic surgery is associated with a myriad of physiologic changes. An understanding of the effect of elevated intra-abdominal pressure on cardiopulmonary, vascular, and renal functions is important as the complexity of the laparoscopic urologic procedures continues to increase. Oliguria and anuria are well-recognized clinical signs of elevated intra-abdominal pressure. The etiology is multifactorial, emanating from vascular and parenchymal compression, and associated with systemic hormonal effects. It is important for the entire operative team to have an understanding of the physiologic effects of CO2 insufflation to provide appropriate intraoperative monitoring and management and minimize intraoperative and postoperative complications.