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Surgical Endoscopy
Published in: Surgical Endoscopy 10/2020

01-10-2020 | Laparoscopy

Modes of carbon dioxide delivery during laparoscopy generate distinct differences in peritoneal damage and hypoxia in a porcine model

Authors: Shienny Sampurno, Timothy J. Chittleborough, Sandra Carpinteri, Jonathan Hiller, Alexander Heriot, Andrew Craig Lynch, Robert George Ramsay

Published in: Surgical Endoscopy | Issue 10/2020

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Abstract

Background

Insufflation with CO2 can employ continuous flow, recirculated gas and/or additional warming and humidification. The ability to compare these modes of delivery depends upon the assays employed and opportunities to minimize subject variation. The use of pigs to train colorectal surgeons provided an opportunity to compare three modes of CO2 delivery under controlled circumstances.

Methods

Sixteen pigs were subjected to rectal resection, insufflated with dry-cold CO2 (DC-CO2) (n = 5), recirculated CO2 by an AirSeal device (n = 5) and humidification and warming (HW-CO2) by a HumiGard device (n = 6). Peritoneal biopsies were harvested from the same region of the peritoneum for fixation for immunohistochemistry for hypoxia-inducible factor 1 alpha (HIF-1α) and scanning electron microscopy (SEM) to evaluate hypoxia induction or tissue/cellular damage, respectively.

Results

DC-CO2 insufflation by both modes leads to significant damage to mesothelial cells as measured by cellular bulging and retraction as well as microvillus shortening compared with HW-CO2 at 1 to 1.5 h. DC-CO2 also leads to a rapid and significant induction of HIF-1α compared with HW-CO2.

Conclusions

DC-CO2 insufflation induces substantive cellular damage and hypoxia responses within the first hour of application. The use of HW-CO2 insufflation ameliorates these processes for the first one to one and half hours in a large mammal used to replicate surgery in humans.
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Metadata
Title
Modes of carbon dioxide delivery during laparoscopy generate distinct differences in peritoneal damage and hypoxia in a porcine model
Authors
Shienny Sampurno
Timothy J. Chittleborough
Sandra Carpinteri
Jonathan Hiller
Alexander Heriot
Andrew Craig Lynch
Robert George Ramsay
Publication date
01-10-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 10/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07213-y

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