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

Abstract

PurposeDuring a laparotomy, the peritoneum is exposed to the cold, dry ambient air of the operating room (20℃, 0%–5% relative humidity). The aim of this review is to determine whether the use of humidified and/or warmed CO2 in the intraperitoneal environment during open or laparoscopic operations influences postoperative outcomes.MethodsA review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, OVID MEDLINE, Cochrane Central Register of Controlled Trials and Embase databases were searched for articles published between 1980 and 2016 (October). Comparative studies on humans or nonhuman animals that involved randomized controlled trials (RCTs) or prospective cohort studies were included. Both laparotomy and laparoscopic studies were included. The primary outcomes identified were peritoneal inflammation, core body temperature, and postoperative pain.ResultsThe literature search identified 37 articles for analysis, including 30 RCTs, 7 prospective cohort studies, 23 human studies, and 14 animal studies. Four studies found that compared with warmed/humidified CO2, cold, dry CO2 resulted in significant peritoneal injury, with greater lymphocytic infiltration, higher proinflammatory cytokine levels and peritoneal adhesion formation. Seven of 15 human RCTs reported a significantly higher core body temperature in the warmed, humidified CO2 group than in the cold, dry CO2 group. Seven human RCTs found lower postoperative pain with the use of humidified, warmed CO2.ConclusionWhile evidence supporting the benefits of using humidified and warmed CO2 can be found in the literature, a large human RCT is required to validate these findings.

Randomized clinical trial of the effect of intraoperative humidified carbon dioxide insufflation in open laparotomy for colorectal resection

“…Human and animal studies have found discrepant results regarding the effect of warmed, humidified carbon dioxide on peritoneal inflammation 30 . In laparoscopic human studies, it was reported 31 that peritoneal damage was less with the use of warmed, humidified carbon dioxide gas insufflation, but another study 32 documented no difference.…”

“…Inflammation is a tightly controlled process with factors that are proinflammatory and anti-inflammatory working simultaneously 30 . Whether localized peritoneal damage will promote a cascade of inflammation to the remaining bowel peritoneum is unclear; however, studies have shown that peritoneal damage is a feature occurring in animals and humans undergoing laparoscopy/laparotomy 30 .…”

Single‐incision laparoscopic reversal of Hartmann's operation through the stoma site: comparative outcomes with conventional laparoscopic and open surgery

“…The use of both CL and SIL in the emergency setting appears safe and feasible, making a laparoscopy-first approach viable [24]. Strategies to further reduce adhesions during laparoscopic surgery may include the insufflation of warmed and humidified carbon dioxide, a technique which we did not use over the time frame of this study [25]. Two systematic reviews have examined the value of laparoscopic techniques for RoH [10,11].…”

<p>The Pathogenesis and Prevention of Port-Site Metastasis in Gynecologic Oncology</p>

“…17 During a conventional laparoscopy, the peritoneum is exposed to the cold, dry ambient air of the operating theatre (20°C, 0%-5% relative humidity), which causes serious peritoneal damage. 17,58 Peng investigated the effect of hyperthermic CO 2 insufflation and humidified CO 2 insufflation on the development of peritoneal dissemination. 59 In their study, mice were divided into two groups and subjected to hyperthermic CO 2 insufflation (43°C, >95% humidity, HT-CO 2 group) or standard normothermic CO 2 insufflation (21°C, <1% relative humidity, NTCO 2 group) for 3 h. Peritoneal dissemination was evaluated quantitatively, and port sites and ascites were observed.…”

“…16 New concepts and methods for PSM prevention have appeared in recent years. 17 We reviewed the hypotheses of PSM pathogeneses in gynecologic oncology. In this way, we wished to summarize the progress in PSM prevention and to select the potential preventive options for patients with gynecologic malignancies.…”