Gases for establishing pneumoperitoneum during laparoscopic abdominal surgery

Lu, Jiong; Cheng, Yao; Xiong, Xian‐Ze; Wu, Sijia; Lin, Yixin; Wu, Taixiang; Cheng, Nan‐Sheng

doi:10.1002/14651858.cd009569

Cited by 2 publications

(3 citation statements)

References 32 publications

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“…As a cause of thought, considering the described side effects of CO 2 pneumoperitoneum in patients undergoing prolonged surgery (e.g. abdominal tumour resection), helium could be considered as an alternative gas as described before [3,13,30,31]. Despite the absence of evidence for fatal gas embolism or life-threatening complications (Cochrane Review [3]), the potential risk for gas embolization remains a concern regarding the higher solubility of helium.…”

Section: Discussionmentioning

confidence: 99%

“…abdominal tumour resection), helium could be considered as an alternative gas as described before [3,13,30,31]. Despite the absence of evidence for fatal gas embolism or life-threatening complications (Cochrane Review [3]), the potential risk for gas embolization remains a concern regarding the higher solubility of helium. Due to the level of technical realization and the higher cost of helium, it did not breakthrough as a routine setup for abdominal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…surgery as this minimally invasive technique has several advantages over laparotomy (LT) such as lower postoperative pain due to smaller incisions, shorter hospital stay and time to recovery [1,2]. In clinical practice, LS is commonly performed establishing a carbon dioxide (CO 2 ) pneumoperitoneum, as it is cheap and inert [3]. Its effect on cardiopulmonary [4][5][6], renal [5,[7][8][9] and metabolic functions [5] as well as on immunologic and inflammatory response [5,10,11] have broadly been investigated, but still little is known about the impact of CO 2 -LS on the liver function.…”

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confidence: 99%

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Severe portal and systemic acidosis during CO2-laparoscopy compared to helium or gasless laparoscopy and laparotomy in a rodent model: an experimental study

et al. 2021

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Background and aims This experimental study assesses the influence of different gases and insufflation pressures on the portal, central-venous and peripheral-arterial pH during experimental laparoscopy. Methods Firstly, 36 male WAG/Rij rats were randomized into six groups (n = 6) spontaneously breathing during anaesthesia: laparoscopy using carbon dioxide or helium at 6 and 12 mmHg, gasless laparoscopy and laparotomy. 45 and 90 min after setup, blood was sampled from the portal vein, vena cava and the common femoral artery with immediate blood gas analysis. Secondly, 12 animals were mechanically ventilated at physiological arterial pH during 90 min of laparotomy (n = 6) or carbon dioxide laparoscopy at 12 mmHg (n = 6) with respective blood gas analyses. Results Over time, in spontaneously breathing rats, carbon dioxide laparoscopy caused significant insufflation pressure-dependent portal acidosis (pH at 6 mmHg, 6.99 [6.95–7.04] at 45 min and 6.95 [6.94–6.96] at 90 min, pH at 12 mmHg, 6.89 [6.82–6.90] at 45 min and 6.84 [6.81–6.87] at 90 min; p < 0.05) compared to laparotomy (portal pH 7.29 [7.23–7.30] at 45 min and 7.29 [7.20–7.30] at 90 min; p > 0.05). Central-venous and peripheral-arterial acidosis was significant but less severely reduced during carbon dioxide laparoscopy. Laparotomy, helium laparoscopy and gasless laparoscopy showed no comparable acidosis in all vessels. Portal and central-venous acidosis during carbon dioxide laparoscopy at 12 mmHg was not reversible by mechanical hyperventilation maintaining a physiological arterial pH (pH portal 6.85 [6.84–6.90] (p = 0.004), central-venous 6.93 [6.90–6.99] (p = 0.004), peripheral-arterial 7.29 [7.29–7.31] (p = 0.220) at 90 min; Wilcoxon–Mann–Whitney test). Conclusion Carbon dioxide laparoscopy led to insufflation pressure-dependent severe portal and less severe central-venous acidosis not reversible by mechanical hyperventilation.

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