TUMOUR CELL MOVEMENT DURING HEATING AND HUMIDIFICATION OF INSUFFLATING CO₂: AN IN VITRO MODEL

Abstract

Background: Intra-operative hypothermia and port-site recurrence have been associated with laparoscopic surgery. Heating and humidification of insufflating CO, may protect against laparoscopy-associated hypothermia. However, the effect of heated, humidified CO, upon tumour cell movement is unknown. Methods: Twenty-four in vitro studies that used 4-L plastic bottles were performed. Thirteen million human colorectal cancer cells were placed in each bottle. Twelve studies used dry room temperature CO, for insufflation; the remaining 12 used heated, humidified COz as the insufflating gas. Both groups were subdivided into bottles with leaks around the trocars and with airtight sealing around the trocars. Two trocars and a laparoscopic grasper were used. The exiting insufflating gas was filtered and examined for the presence of cells. Laparoscopic instruments agitated the contents of the bottles. The instruments and trocars were washed. These washings were examined for the presence of cells. Results: Heated, humidified CO, insufflation was able to maintain a warmer and more humid environment within the bottles when compared with dry room-temperature CO,. No cells were detected on the gas filters. Tumour cells were found on 12 out of 12 instruments and 1 I out of 12 trocars with dry CO, insufflation. Tumour cells were found on 8 out of 12 instruments and 7 out of 12 trocars with heated humidified CO, insufflation. The only statistically significant difference in tumour cell spread to trocars was found between heating and humidification when no leak was present, and heating and humidification with leak present, and dry insufflation with no leak present ( P = 0.015, Fisher's two-tailed exact test). Conclusions: Heating and humidifying CO, during in vitro laparoscopy does not increase the aerosolization of tumour cells when compared with dry CO,. However, the use of heated and humidified gas with airtight seals around the trocars in vitro may lessen cell deposition on trocars.

Increased peritoneal dissemination after laparotomy versus pneumoperitoneum in a mouse cecal cancer model

“…Le Moine et al [15] reported that laparoscopic cecal resection significantly increased the incidence of a diffuse carcinomatosis, even when performed for locally noninvasive tumors, and emphasized the risk of increased peritoneal dissemination after laparoscopic surgery from manipulation of cancer cells in surgical procedures. Brundell et al [3] and Texler et al [20] also demonstrated by in vitro and in vivo experiments that instrumental manipulation, mechanical tumor cell spillage, and local metabolism played the important role in port-site seeding of cancer cells after CO 2 pneumoperitoneum. On the other hand, morphologic studies with electron microscopy by Suematsu et al [18] and Volz et al [21] showed that peritoneal mesothelial cells were exfoliated and the basal membrane was exposed soon after surgical procedures.…”

Heated and Humidified CO2 Prevents Hypothermia, Peritoneal Injury, and Intra-Abdominal Adhesions During Prolonged Laparoscopic Insufflations

“…The serious peritoneal injury after prolonged cold-dry CO 2 insufflations may increase the risk of peritoneal metastasis and port site metastasis in laparoscopic cancer surgery. Whether the heated-humidified CO 2 can prevent them is unknown, although it was reported to reduce tumor growth and spread after short-duration [23,24,58]. Further investigations into this area are warranted.…”

Effects of Intraoperative Insufflation With Warmed, Humidified CO2 during Abdominal Surgery: A Review

“…Furthermore, Texler et al [ 46 ] examined the spread of tumor cells in warmed, humidified CO 2 and cold, dry CO 2 environments in vitro . A total of 24 tumor cell cultures were insufflated with CO 2 in an airtight environment, and laparoscopic instruments were used to agitate the contents of the bottle.…”