Modes of carbon dioxide delivery during laparoscopy generate distinct differences in peritoneal damage and hypoxia in a
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and Other Interventional Techniques
Modes of carbon dioxide delivery during laparoscopy generate distinct differences in peritoneal damage and hypoxia in a porcine model Shienny Sampurno1 · Timothy J. Chittleborough1 · Sandra Carpinteri1 · Jonathan Hiller1 · Alexander Heriot1 · Andrew Craig Lynch1 · Robert George Ramsay1,2 Received: 25 March 2019 / Accepted: 9 October 2019 © The Author(s) 2019
Abstract Background Insufflation with CO2 can employ continuous flow, recirculated gas and/or additional warming and humidification. The ability to compare these modes of delivery depends upon the assays employed and opportunities to minimize subject variation. The use of pigs to train colorectal surgeons provided an opportunity to compare three modes of C O2 delivery under controlled circumstances. Methods Sixteen pigs were subjected to rectal resection, insufflated with dry-cold CO2 (DC-CO2) (n = 5), recirculated CO2 by an AirSeal device (n = 5) and humidification and warming (HW-CO2) by a HumiGard device (n = 6). Peritoneal biopsies were harvested from the same region of the peritoneum for fixation for immunohistochemistry for hypoxia-inducible factor 1 alpha (HIF-1α) and scanning electron microscopy (SEM) to evaluate hypoxia induction or tissue/cellular damage, respectively. Results DC-CO2 insufflation by both modes leads to significant damage to mesothelial cells as measured by cellular bulging and retraction as well as microvillus shortening compared with HW-CO2 at 1 to 1.5 h. DC-CO2 also leads to a rapid and significant induction of HIF-1α compared with HW-CO2. Conclusions DC-CO2 insufflation induces substantive cellular damage and hypoxia responses within the first hour of application. The use of HW-CO2 insufflation ameliorates these processes for the first one to one and half hours in a large mammal used to replicate surgery in humans. Keywords Pig surgery · Laparoscopy · Hypoxia · Peritoneal damage Laparoscopic surgery is a mainstay of investigational and interventional management of patients with abdominal cancer [1–5]. The delivery of carbon dioxide (CO2) to generate a pneumoperitoneum facilitates visualization, access, biopsy and removal of tumor [1, 6–9]. There have been parallel advances in technology designed to optimize various features of C O2 delivery. These technologies include warming, Shienny Sampurno and Timothy J. Chittleborough contributed equally to this study. * Robert George Ramsay [email protected] 1
Peter MacCallum Cancer Centre and The Sir Peter MacCallum, Department of Oncology, University of Melbourne, Melbourne, Australia
Differentiation and Transcription Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
2
humidification, gas recycling as well as pressure stabilization [8, 9]. Laparoscopy can be employed to stage a patients’ tumor prior to surgical planning. However, there is an open question of whether the procedure of the insufflation has any adverse consequences to the structural and functional integrity of the peritoneum, most particul
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