The “Dark Side” of Pneumoperitoneum and Laparoscopy

Abstract

Laparoscopic surgery has been one of the most common procedures for abdominal surgery at pediatric age during the last few decades as it has several advantages compared to laparotomy, such as shorter hospital stays, less pain, and better cosmetic results. However, it is associated with both local and systemic modifications. Recent evidence demonstrated that carbon dioxide pneumoperitoneum might be modulated in terms of pressure, duration, temperature, and humidity to mitigate and modulate these changes. The aim of this study is to review the current knowledge about animal and human models investigating pneumoperitoneum-related biological and histological impairment. In particular, pneumoperitoneum is associated with local and systemic inflammation, acidosis, oxidative stress, mesothelium lining abnormalities, and adhesion development. Animal studies reported that an increase in pressure and time and a decrease in humidity and temperature might enhance the rate of comorbidities. However, to date, few studies were conducted on humans; therefore, this research field should be further investigated to confirm in experimental models and humans how to improve laparoscopic procedures in the spirit of minimally invasive surgeries.

Effect of Surgical Humidification on Inflammation and Peritoneal Trauma in Colorectal Cancer Surgery: A Randomized Controlled Trial

“…This prospective RCT has confirmed some expectations informed by pre-clinical studies in mice and pigs 11 – 13 , 22 as well as revealing unanticipated biology of patients undergoing surgery for CRC. The need to explore the impact of generating a pneumoperitoneum for laparoscopic surgery has been raised by others 24 and here we addressed clinical and biological parameters in laparoscopic and open surgery cohorts.…”

Randomized Trial of Ultralow vs Standard Pneumoperitoneum during Robotic Prostatectomy

“…A growing body of evidence demonstrates the deleterious effects of pneumoperitoneum and risks associated with traditional pressure settings. 16,17 While the urological literature has few such studies, improvement in pain and LOS at lower pressures during laparoscopic cholecystectomy has been demonstrated extensively. 8 Hua et al performed a meta-analysis of 22 randomized trials comparing standard (12e15 mmHg) vs low pressure (7e10 mmHg) laparoscopic cholecystectomy and found significant reductions in postoperative pain at all time frames with lower pressures.…”

Laparoscopic versus Open Ovariectomy in Bitches: Changes in Cardiorespiratory Values, Blood Parameters, and Sevoflurane Requirements Associated with the Surgical Technique

“…Another critical event is associated with the insufflation of CO 2 and its absorption through the abdominal cavity, which may produce acid-base and cardiorespiratory disturbances [ 21 ]. Presently, it is well-known that the severity of these alterations is positively correlated with higher IAP pressures [ 22 , 23 ]. For that reason, the current veterinary literature supports the use of IAP of maximum 10 mmHg in dogs [ 24 , 25 ] and below 6–8 mmHg in cats [ 26 , 27 , 28 ].…”