Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Gynecological Surgery
Published in: Gynecological Surgery 1/2017

Open Access 01-12-2017 | Original Article

N2O strongly prevents adhesion formation and postoperative pain in open surgery through a drug-like effect

Authors: Roberta Corona, Maria Mercedes Binda, Leila Adamyan, Victor Gomel, Philippe R. Koninckx

Published in: Gynecological Surgery | Issue 1/2017

Login to get access

Abstract

Background

Microsurgical tenets and peritoneal conditioning during laparoscopic surgery (LS) decrease postoperative adhesions and pain. For a trial in human, the strong beneficial effects of N2O needed to be confirmed in open surgery (OS).

Results

In a mouse model for OS, the effect of the gas environment upon adhesions was evaluated. Experiment I evaluated desiccation and the duration of exposure to CO2, N2O or CO2 + 4%O2. Experiment II evaluated the dose-response curve of adding N2O to CO2. Experiment III compared humidified CO2 + 10% N2O during LS and OS.
In OS, 30- and 60-min exposure to non-humidified CO2 caused mortality of 33 and 100%, respectively. Mortality was prevented by humidification, by dry N2O or dry CO2 + 4%O2. Adhesions increased with the duration of exposure to CO2 (p < 0.0001) and decreased slightly by humidification or by the addition of 4% O2. N2O strongly decreased adhesions at concentrations of 5% or greater. With humidified CO2 + 10% N2O, adhesion formation was similar in OS and LS.

Conclusions

The drug-like and strong beneficial effect of low concentrations of N2O is confirmed in OS.
Literature
1.
Mutsaers SE, Prele CM, Pengelly S, Herrick SE (2016) Mesothelial cells and peritoneal homeostasis. Fertil Steril 106:1018–1024CrossRefPubMed
2.
Koninckx PR, Gomel V, Ussia A, Adamyan L (2016) Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue. Fertil Steril 106:998–1010CrossRefPubMed
3.
Corona R, Verguts J, Schonman R, Binda MM, Mailova K, Koninckx PR (2011) Postoperative inflammation in the abdominal cavity increases adhesion formation in a laparoscopic mouse model. Fertil Steril 95:1224–1228CrossRefPubMed
4.
Matsuzaki S, Jardon K, Maleysson E, D'Arpiany F, Canis M, Bazin JE, Mage G (2010) Carbon dioxide pneumoperitoneum, intraperitoneal pressure, and peritoneal tissue hypoxia: a mouse study with controlled respiratory support. Surg Endosc. 2010;24:2871–80
5.
Donnez J, Binda MM, Donnez O, Dolmans MM (2016) Oxidative stress in the pelvic cavity and its role in the pathogenesis of endometriosis. Fertil Steril 106:1011–1017CrossRefPubMed
6.
Shimomura M, Hinoi T, Ikeda S, Adachi T, Kawaguchi Y, Tokunaga M, Sasada T, Egi H, Tanabe K, Okajima M, Ohdan H (2013) Preservation of peritoneal fibrinolysis owing to decreased transcription of plasminogen activator inhibitor-1 in peritoneal mesothelial cells suppresses postoperative adhesion formation in laparoscopic surgery. Surgery 153:344–356CrossRefPubMed
7.
Matsuzaki S, Botchorishvili R, Jardon K, Maleysson E, Canis M, Mage G (2011) Impact of intraperitoneal pressure and duration of surgery on levels of tissue plasminogen activator and plasminogen activator inhibitor-1 mRNA in peritoneal tissues during laparoscopic surgery. Hum Reprod 26:1073–1081CrossRefPubMed
8.
9.
Koninckx PR, Corona R, Timmerman D, Verguts J, Adamyan L (2013) Peritoneal full-conditioning reduces postoperative adhesions and pain: a randomised controlled trial in deep endometriosis surgery. J Ovarian Res 6:90CrossRefPubMedPubMedCentral
10.
Gomel V, Koninckx PR (2016) Microsurgical principles and postoperative adhesions: lessons from the past. Fertil Steril 106:1025–1031CrossRefPubMed
11.
Gomel V (2016) Reconstructive tubal microsurgery and assisted reproductive technology. Fertil Steril 105:887–890CrossRefPubMed
12.
Corona R, Verguts J, Koninckx R, Mailova K, Binda MM, Koninckx PR (2011) Intraperitoneal temperature and desiccation during endoscopic surgery. Intraoperative humidification and cooling of the peritoneal cavity can reduce adhesions. Am J Obstet Gynecol 205:392–397CrossRefPubMed
13.
Binda MM, Molinas CR, Hansen P, Koninckx PR (2006) Effect of desiccation and temperature during laparoscopy on adhesion formation in mice. Fertil Steril 86:166–175CrossRefPubMed
14.
Molinas CR, Tjwa M, Vanacker B, Binda MM, Elkelani O, Koninckx PR (2004) Role of CO2 pneumoperitoneum-induced acidosis in CO2 pneumoperitoneum-enhanced adhesion formation in mice. Fertil Steril 81:708–711CrossRefPubMed
15.
Pouly JL, Seak-San S (2000) Adhesions: laparoscopy versus laparotomy. Peritoneal surgery. Springer-Verlag, New York
16.
Armitage P, Berry G (1987) Factorial designs. Statistical methods in medical research, 2nd edn, Oxford: Blackwell Scientific Publications; 227–39
17.
Inc SI (1988). In: Inc SI (ed) Sas/stat users guide. Cary NC : SAS Institute Inc,
18.
Corona R, Binda MM, Mailova K, Verguts J, Koninckx PR (2013) Addition of nitrous oxide to the carbon dioxide pneumoperitoneum strongly decreases adhesion formation and the dose-dependent adhesiogenic effect of blood in a laparoscopic mouse model. Fertil Steril 100:1777–1783CrossRefPubMed
19.
Ryan GB, Grobety J, Majno G (1971) Postoperative peritoneal adhesions. A study of the mechanisms. Am J Pathol 65:117–148PubMedPubMedCentral
20.
21.
Cwalinski J, Breborowicz A, Polubinska A (2016) The impact of 0.9% NaCl on mesothelial cells after intraperitoneal lavage during surgical procedures. Adv Clin Exp Med 25:1193–1198CrossRefPubMed
22.
Cwalinski J, Staniszewski R, Baum E, Jasinski T, Mackowiak B, Breborowicz A (2015) Normal saline may promote formation of peritoneal adhesions. Int J Clin Exp Med 8:8828–8834PubMedPubMedCentral
23.
Polubinska A, Breborowicz A, Staniszewski R, Oreopoulos DG (2008) Normal saline induces oxidative stress in peritoneal mesothelial cells. J Pediatr Surg 43:1821–1826CrossRefPubMed
24.
Breborowicz A, Polubinska A, Breborowicz M, Simon M, Wanic-Kossowska M, Oreopoulos DG (2007) Peritoneal effects of intravenous iron sucrose administration in rats. Transl Res 149:304–309CrossRefPubMed
25.
Breborowicz A, Oreopoulos DG (2005) Is normal saline harmful to the peritoneum? Perit Dial Int 25(Suppl 4):S67–S70PubMed
26.
Lin HF, Wu CY, Wu MC, Chou TH, Lin GS, Yen ZS, Chen SC (2014) Hypothermia decreases postoperative intra-abdominal adhesion formation. Am J Surg. 2014;208:419–24
27.
Fang CC, Chou TH, Lin GS, Yen ZS, Lee CC, Chen SC (2010) Peritoneal infusion with cold saline decreased postoperative intra-abdominal adhesion formation. World J Surg 34:721–727CrossRefPubMed
28.
de Vries A, Marvik R, Kuhry E (2013) To perform operative procedures in an optimized local atmosphere: can it reduce post-operative adhesion formation? Int J Surg 11:1118–1122CrossRefPubMed
29.
Frey JM, Janson M, Svanfeldt M, Svenarud PK, van der Linden JA (2012) Local insufflation of warm humidified CO2 increases open wound and core temperature during open colon surgery: a randomized clinical trial. Anesth Analg 115:1204–1211CrossRefPubMed
30.
van der Linden J, Persson M (2009) CO2 field flooding may also reduce oxidative stress in open surgery. Anesth Analg 109:683–684CrossRefPubMed
31.
Metadata
Title
N2O strongly prevents adhesion formation and postoperative pain in open surgery through a drug-like effect
Authors
Roberta Corona
Maria Mercedes Binda
Leila Adamyan
Victor Gomel
Philippe R. Koninckx
Publication date
01-12-2017
Publisher
Springer Berlin Heidelberg
Published in
Gynecological Surgery / Issue 1/2017
Print ISSN: 1613-2076
Electronic ISSN: 1613-2084
DOI
https://doi.org/10.1186/s10397-017-1024-2

Other articles of this Issue 1/2017

Gynecological Surgery 1/2017 Go to the issue

Original Article

Laparoscopic uterovaginal prolapse surgery in the elderly: feasibility and outcomes

Review article

The role of the multidisciplinary team in the management of deep infiltrating endometriosis

Original Article

The effect of music in gynaecological office procedures on pain, anxiety and satisfaction: a randomized controlled trial

Editorial

Your contribution to Gynecological Surgery now freely available to the global scientific community

Original Article

Oophoropexy for ovarian torsion: a new easier technique

Opinion

AAGL practice report: practice guidelines on intrauterine adhesions developed in collaboration with the European Society of Gynaecological Endoscopy (ESGE)