Cancer Biology Relating to Minimal Access Management

Salo, Jonathan C.

doi:10.1007/978-1-4419-1238-1_2

Cited by 1 publication

(1 citation statement)

References 166 publications

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“…Port site metastases are now thought to be more related to intraoperative handling of the cancer, contamination by the operating surgeon's laparoscopic instruments or increased peritoneal trauma. Laparoscopic surgery in patients with locally advanced gastrointestinal cancers where there is greater risk of tumour manipulation and dissemination is still of concern [89].…”

Section: Prevention Of Tumour Implantation By Warm Humidified Comentioning

confidence: 99%

Changes in the coelomic microclimate during carbon dioxide laparoscopy: morphological and functional implications

Wilson

2017

Pleura and Peritoneum

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In this article the adverse effects of laparoscopic CO 2 -pneumoperitoneum and coelomic climate change, and their potential prevention by warmed, humidified carbon dioxide insufflation are reviewed. The use of pressurized cold, dry carbon dioxide (C0 2 ) pneumoperitoneum causes a number of local effects on the peritoneal mesothelium, as well as systemic effects. These can be observed at a macroscopic, microscopic, cellular and metabolic level. Local effects include evaporative cooling, oxidative stress, desiccation of mesothelium, disruption of mesothelial cell junctions and glycocalyx, diminished scavenging of reactive oxygen species, decreased peritoneal blood flow, peritoneal acidosis, peritoneal hypoxia or necrosis, exposure of the basal lamina and extracellular matrix, lymphocyte infiltration, and generation of peritoneal cytokines such as IL-1, IL-6, IL-8 and TNFα. Such damage is increased by high CO 2 insufflation pressures and gas velocities and prolonged laparoscopic procedures. The resulting disruption of the glycocalyx, mesothelial cell barrier and exposure of the extracellular matrix creates a cascade of immunological and proinflammatory events and favours tumour cell implantation. Systemic effects include cardiopulmonary and respiratory changes, hypothermia and acidosis. Such coelomic climate change can be prevented by the use of lower insufflation pressures and preconditioned warm humidified CO 2 . By achieving a more physiological temperature, pressure and humidity, the coelomic microenvironment can be better preserved during pneumoperitoneum. This has the potential clinical benefits of maintaining isothermia and perfusion, reducing postoperative pain, preventing adhesions and inhibiting cancer cell implantation in laparoscopic surgery.

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Section: Prevention Of Tumour Implantation By Warm Humidified Comentioning

confidence: 99%

Changes in the coelomic microclimate during carbon dioxide laparoscopy: morphological and functional implications

Wilson

2017

Pleura and Peritoneum

View full text Add to dashboard Cite

show abstract

Cancer Biology Relating to Minimal Access Management

Cited by 1 publication

References 166 publications

Changes in the coelomic microclimate during carbon dioxide laparoscopy: morphological and functional implications

Changes in the coelomic microclimate during carbon dioxide laparoscopy: morphological and functional implications

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