THE POTENTIAL DANGER OF THROMBOSIS IN RETROPERITONEAL ENDOSURGERY

Lobanov Yuri Sergeevich, Shapovalov Konstantin Gennadievich, Lobanov Sergey Leonidovich, Lobanov Leonid Sergeevich, Aksenov Konstantin O.

Retroperitoneal space surgery using retroperitoneal access is actively developing. The possibility of surgical manipulation requires the creation and maintenance of a retropneumoperitoneum. In this case, compression of tissues and vascular structures in the retroperitoneal space occurs. This can lead to a violation of microcirculation. This phenomenon is insufficiently studied. The question of the effect of retropneumoperitoneum on the state of the endothelium and the potential danger of thrombotic complications remains unclear. The purpose of the work: to study the state of the endothelium and platelet activity, at different levels of gas pressure in the conditions of the retropneumoperitoneum, during operations in the retroperitoneal space. Material and methods: Studies were conducted in 44 patients operated on for kidney cysts using retroperitoneal access. . The first group included 20 patients whose pressure level in the retroperitoneal space did not exceed 12 mmHg, the second group included 24 patients -12 mmHg and higher. Platelet aggregation, lymphocyte adhesion to platelets (LTA), endothelial functions: endothelin-1 level, the number of circulating endothelial cells (CEC) were determined as markers of venous thrombosis. Results and discussion. In the 1st group of patients, no significant changes in the studied indicators were detected. In the second group, an increase in the level and rate of induced aggregation was found by 11% and 14%. In group 2, a significant increase in the level of endothelin-1 and circulating endothelial cells, as well as the degree of platelet adhesion to lymphocytes, was found. Conclusion. With higher compression (more than 12 mmHg), induced platelet aggregation increases and signs of endothelial dysfunction appear, which may indicate a violation of microcirculation and an increased risk of thrombotic complicati.

Keywords:retroperitoneal space surgery, retropneumoperitoneum, platelet aggregation, endothelium