Electron-Microscopic Alterations of the Peritoneum after Both Cold and Heated Carbon Dioxide Pneumoperitoneum

Erikoğlu, Mehmet; Yol, Serdar; Avunduk, Mustafa Cihat; Erdemlı, Esra; Can, Alp

doi:10.1016/j.jss.2004.11.029

Cited by 58 publications

(58 citation statements)

References 6 publications

(17 reference statements)

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“…In addition, it is easily eliminated from the bloodstream through increased ventilation [3]. However, in recent years, many studies have shown that laparoscopic surgery may cause transient or persistent side effects in intra-abdominal or extra-abdominal organs that are closely related to the type, temperature, and pressure level of the gas used and the duration of the application [2][3][4][5]. Although some of these studies are extreme research models, it is known that stimulated immune response, cytokine releases in response to free radicals production, and ischemia/reperfusion model occur in almost all cases [6,7].…”

Section: Introductionmentioning

confidence: 99%

p53 expression and apoptosis in liver and spleen during CO2 pneumoperitoneum

Arıkan

Tosun

Şaykol

et al. 2007

Langenbecks Arch Surg

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Section: Introductionmentioning

confidence: 99%

p53 expression and apoptosis in liver and spleen during CO2 pneumoperitoneum

Arıkan

Tosun

Şaykol

et al. 2007

Langenbecks Arch Surg

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“…The morphology of mesothelial cells under SEM when exposed to heated and humidified CO 2 is similar to control animals, with little inflammatory response [13,29]. Inflammatory responses to pneumoperitoneum, as measured by IL-6 and CRP release, can be increased by as much as four times with cold/dry or warm/dry CO 2 in comparison to warm/humidified gas [2].…”

Section: Prevention Of Desiccationmentioning

confidence: 94%

“…Ott (2003) introduced the concept of the 'desertification' of the peritoneum due to surface evaporation and desiccation with the use of dry CO 2 [2]. With cold-dry CO 2 -pneumoperitoneum under SEM, drastic alterations of the peritoneal surface layer are seen, with microvilli loss, extreme desquamation of mesothelial cells, and obvious exposure of the basal membrane [13,18,29] (see Figure 1). In a fully water saturated CO 2 pneumoperitoneum (relative humidity 100 %) with a temperature similar to the surrounding tissues of 37°C, no further evaporation from the peritoneal serous layer can occur [5].…”

Section: Prevention Of Desiccationmentioning

confidence: 99%

“…Prevention of initial tumour implantation by warmed humidified CO 2 vs. cold-dry CO 2 -pneumoperitoneum may be related to preservation of the peritoneal mesothelial glycocalyx, microvilli and high molecular weight HA [13,18,29,91]. Reducing peritoneal desiccation, peritoneal inflammation [5,69] and cytokine generation can also potentially inhibit cancer cell interaction with peritoneal mesothelial cells and the ECM [18,90,91].…”

Section: Prevention Of Tumour Implantation By Warm Humidified Comentioning

confidence: 99%

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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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“…[39,40] Recent evidence suggests that the use of continuous flow of cool, dry CO2 to create a PNP during laparoscopy does not simply create a working space for surgery, but can also lead to adverse structural, metabolic, and immune dearrangements within the peritoneal mesothelial layer and that these can be dependent on the specific insufflation of the gas used. [25,31,38,[41][42][43] How much of this effect relates to intrinsic properties of CO2, and how much is due to the desiccative effect of the gas is not clear. [37,44] Another possible component of injury is the impact on microcirculation due to the increased intraperitoneal pressure (IPP) at both the parietal (subperitoneal) and the visceral level.…”

Section: Peritoneum;mentioning

confidence: 99%

Abdominal Effects Of Laparoscopic Surgery

Tolan¹

2017

Laparosc Endosc Surg Sci

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Pneumoperitoneum (PNP) is very commonly performed in surgical practice due to the extensive use of laparoscopic surgery. In minimally invasive surgery, there is an effort to convert all eligible surgical procedures to a laparoscopic technique, as it has fewer systemic and local surgical effects on the patient. During PNP, intraperitoneal pressure (IPP) is increased to well above normal intra-abdominal pressure in order to create an opening for visualization of the abdominal contents. The duration of these procedures can be prolonged as a result of the difficulties and complexities of these techniques. IPP has side effects on the physiology of patients, as is seen in abdominal compartment syndrome.

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Electron-Microscopic Alterations of the Peritoneum after Both Cold and Heated Carbon Dioxide Pneumoperitoneum

Cited by 58 publications

References 6 publications

p53 expression and apoptosis in liver and spleen during CO2 pneumoperitoneum

p53 expression and apoptosis in liver and spleen during CO2 pneumoperitoneum

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

Abdominal Effects Of Laparoscopic Surgery

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