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Modes of carbon dioxide delivery during laparoscopy generate distinct differences in peritoneal damage and hypoxia in a porcine model

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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 CO2 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.

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Acknowledgements

We thank the Centre for Advanced Histology and Microscopy for their expert advice regarding scanning electron microscopy and immunohistochemistry.

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Author notes

  1. Shienny Sampurno and Timothy J. Chittleborough contributed equally to this study.

Authors and Affiliations

  1. Peter MacCallum Cancer Centre and The Sir Peter MacCallum, Department of Oncology, University of Melbourne, Melbourne, Australia

    Shienny Sampurno, Timothy J. Chittleborough, Sandra Carpinteri, Jonathan Hiller, Alexander Heriot, Andrew Craig Lynch & Robert George Ramsay

  2. Differentiation and Transcription Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia

    Robert George Ramsay

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  1. Shienny Sampurno
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Correspondence to Robert George Ramsay.

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Disclosures

This work was supported in part by the Epworth Hospital Research Foundation (Drs Lynch and Ramsay) and the National Health and Medical Research Council of Australia (Drs Heriot and Ramsay). Fisher and Paykel Healthcare made a loan of HumiGards for this study. Ms Sampurno, Drs Chittleborough, Carpinteri and Hiller and Heriot have no disclosures. Drs Lynch and Ramsay have received research grant funding from Fisher and Paykel Healthcare for separate small animal studies. Prof Ramsay also receives research support associated with unconnected clinical trials from Targovax, Oslo; Merck Serono, Germany and Beigene Sciences, Australia.

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Sampurno, S., Chittleborough, T.J., Carpinteri, S. et al. Modes of carbon dioxide delivery during laparoscopy generate distinct differences in peritoneal damage and hypoxia in a porcine model. Surg Endosc 34, 4395–4402 (2020). https://doi.org/10.1007/s00464-019-07213-y

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  • DOI: https://doi.org/10.1007/s00464-019-07213-y

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