Patients undergoing warmed, humidified carbon dioxide (CO 2) insufflation for laparoscopic cholecystectomy will (1) maintain a warmer intraoperative core temperature, (2) have their surgeon experience less fogging of the camera lens, and (3) have less postoperative pain than patients undergoing laparoscopic cholecystectomy with standard CO 2 insufflation. Design: A double-blind, prospective, randomized study comparing patients undergoing laparoscopic cholecystectomy with standard CO 2 insufflation vs those receiving warmed, humidified CO 2 (Insuflow Filter Heater Hydrator; Lexion Medical, St Paul, Minn) was performed. Main variables included patient core temperature, postoperative pain, analgesic requirements, and camera lens fogging. Results: One hundred one blinded patients (69 women, 32 men) undergoing laparoscopic cholecystectomy were randomized into 2 groups-52 receiving standard CO 2 insufflation (group A) and 49 receiving warmed, humidified CO 2 (group B). Mean patient intraoperative core temperature change (group A decreased by 0.03°C, group B increased by 0.29°C, P=.01) and mean abdominal pain (Likert scale, 0-10) at 14 days postoperatively (group A, 1.0; group B, 0.3; P =.02) were different. Other variables (camera lens fogging, early postoperative pain, narcotic requirements, recovery room stay, and return to normal activities) between groups were similar. Conclusion: While patients undergoing laparoscopic cholecystectomy with warmed, humidified CO 2 had several advantages that were statistically significant, no major clinically relevant differences between groups A and B were evident.

When considering prophylactic repair during TEP explorations, a yearly risk of 1.2% of developing a contralateral hernia after negative exploration needs to be balanced against the low but potential risk of groin pain following prophylactic repair.

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Prior TEP/TAPP did not increase the morbidity or mortality of subsequent prostate surgery. Despite some subjective operative difficulty, open prostatectomy was safe and feasible in all cases with a comparable oncologic outcome. Mesh-associated inflammation may preclude adequate nodal sampling. While endoscopic hernia repair remains an excellent option to fix unilateral, bilateral, and recurrent herniae, consideration of future prostate surgery is important. Inserting less "inflammatory" mesh or using an open, anterior approach may be prudent in some men at high risk for needing subsequent prostate surgery.

The crucial risk factor for groin hematoma developing in patients undergoing inguinal hernia repair is preoperative need for Coumadin therapy. Although the perioperative management of anticoagulation in patients undergoing inguinal herniorrhaphy is not clearly defined, meticulous management of patients requiring Coumadin therapy seems prudent.