Transcutaneous Electrical Acupoint Stimulation For Hepatic And Renal Dysfunction After Pneumoperitoneum

Laparoscopic surgery has been widely applied due to advantages including less invasive intervention, more rapidly recovery and better surgical field. And more advanced laparoscopic techniques – Da Vinci robotic operation system appears in recent years with the development of science.Laparoscopic surgery has showen disadvantages as well. Carbon dioxide?CO₂? is used to inflate the abdomen in order to give the surgeon enough room to manipulate. However, pneumoperitoneum may exert influences on abdominal organs. First, pressure of pneumoperitoneum may reduce the blood supply of the organs, and when pressure disappeared, the organ blood flow will recover and may cause ischemia-reperfusion injury. Second, absorption of CO₂ causes hypercapnia, lower pH and tissue perfusion, and increased metabolites. In addition, patients are put in specific positions to obtain a good surgical field during the laparoscopic surgery, such as, the extreme head-down position?Trendelenburg position?, which will also cause certain influence on the organ blood flow. Animal and clinical experiments have confirmed the effect of pneumoperitoneum with CO₂ on renal function but there is still controversy for its clinical significance. Liver and kidney are important organs for drug metabolism. The change of their functions may have significant clinical significance, especially in the patients with hepatic or renal dysfunction. Researchers did many efforts to alleviate the hepatic and renal function damage caused by pneumoperitoneum. Efforts include low pneumoperitoneum pressure and pharmaceutics which may reduce the liver and kidney damages.Acupuncture is an important part of traditional Chinese medicine. Electric acupuncture?EA? is a technique combining electronic technology and traditional acupuncture. Electro-acupuncture preconditioning has been proved to reduce organ ischemia damage of the brain, spinal cord, and heart. The possible mechanisms include reducing oxidative stress damage, improvd microcirculation, improved endothelial cell function, etc. Researchers have confirmed that electro-acupuncture has protective effect on ischemia-reperfusion organs. Pneumoperitoneum induced hepatic and renal damage may share similar mechanism with cerebral ischemia-perfusion damage process. So the experiments were designed to verify the adverse effect of pneumoperitoneum on hepatic and renal function, and to explore the protective effect of transcutaneous electrical acupoint stimulation. Experiment 1: Preliminary clinical studies about the effect of pneumoperitoneum on hepatic and renal function in patients. Objective: To observe the effect of pneumoperitoneum on hepatic and renal function in Da Vinci robotic assisted laparoacopic gynecologic surgery. Method: 20 patients undergoing robotic assisted laparoacopicgynecologic surgery?R group? and the other 20 undergoing open surgery?O group?. 4 ml of venous blood was collected before induction and 30 minutes after the operation, to measure the level of aspartate transaminase?AST?, alanine transaminase?ALT?, blood urea nitrogen?BUN?, and creatinine?Cr?. Results: There was an increase in both BUN and Cr after surgery in both groups. Compared with baseline, there was no statistical significance of BUN and Cr after surgery in O group, but a significantly increase?P < 0.05? in R group. Same changes were seen in respect to ALT and AST. They both significantly increased in R group, but did not change in O group. Conclusions: A long duration pneumoperitoneum results in increased serum ALT, AST, BUN and Cr. Control the pneumoperitoneum time, may be needed to prevent the damage on liver and kidney. Experiment 2: Protective effect of transcutaneous electrical acupoint stimulation onhepatic and renal function after pneumoperitoneum. Objective: To observe the protective effect of transcutaneous acupoint stimulation in neiguan and zusanli points on hepatic and renal function measurements and inflammatory factors after pneumoperitoneum. Method: 130 patients undergoing laparoscopic gynecologic surgery were screened and 92 finished the study?32 in T group, 31 in N group and 29 in group C?. Transcutaneous acupoint electrical stimulation was applied in T group from 30 mins before operation and continued until the end of surgery; N group received transcutaneous electrical stimulation at non-acupoint from 30 mins before surgery to the end of surgery. Electrodes were attached on acupoints and non-acupoints in group C but no electrical stimulation was given. 4 ml of venous blood was collected before stimulation and 30 mins after pneumoperitoneum to test blood aspertate aminotransferase?AST?, alanine aminotransferase?ALT?, alkaline phosphatase?ALP?, urea nitrogen?BUN?, creatinine?Cr?, and inflammatory factors including IL- 6, TNF-?, CRP, PGE2. All the serum samples were tested in Xijing hospital clinical laboratory. Results: Compared with group N and C, the percentage changes of ALT, AST and ALP were significantly larger in group T?P < 0.05?. The level of ALT, AST and ALP decreased after surgery in group T. The change of TBIL did not differ among groups. Similarly, compared with group N and C, the percentage changes of BUN and Cr were significantly larger in group T?P < 0.05?. The level of BUN and Cr decreased after surgery in group T. Same trends were seen in respect to IL- 6, PEG2 and CRP. However, no difference was found in respect to TNF-? level. Conclusions: Patients undergoing surgery under long-duration pneumoperitoneum may suffer from increased ALT, AST, ALP, BUN, Cr and inflammatory factors.Transcutaneous electrical stimulation in neiguan and zusanli mayprotect the hepatic and renal function after pneumoperitoneum. Summary: Pneumoperitoneum with CO₂ during laparoscopic surgery can cause hepatic and renal dysfunction, transcutaneous electrical acupoint stimulation may alleviate this dysfunction.During laparoscopic surgery, attention should be paid to the duration of peritoneum to avoid damage on liver and kidney.