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SAN FRANCISCO -- Gasless laparoscopic-assisted vaginal hysterectomy produced fewer hemodynamic and pulmonary changes during surgery than when carbon dioxide pneumatic abdominal distension was used, Dr. Bernd Bojahr reported.
A prospective, randomized study of 30 healthy patients undergoing laparoscopic-assisted vaginal hysterectomy (LAVH) for large uterine myomas found significantly greater impairments in lung compliance in the 15 women randomized to LAVH with [CO.sub.2] insufflation. Lung compliance decreased by an average of 58% in the [CO.sub.2] group when patients were placed in the Trendelenburg position. These and other changes were partially or completely reversed by placing the patient in the horizontal position for the vaginal part of the surgery. Lung compliance did not change significantly during surgery in the 15 women who underwent gasless LAVH with mechanical abdominal wall distension, he said at the annual meeting of the American Association of Gynecologic Laparoscopists.
Higher mean arterial pressures in the [CO.sub.2] group at all measurement times were of borderline statistical significance. The central venous pressure, the base excess, and end tidal [CO.sub.2] readings increased significantly in the [CO.sub.2] group but not the ...