Abstract
Background
CO2 pneumoperitoneum (PP) during laparoscopic surgery, can cause hypoxia and desiccation
in the peritoneal mesothelial cell, resulting in a time-dependent retraction and bulging
of these cells, an acute inflammatory reaction and enhanced adhesion formation. Since
hypoxia is prevented by adding 4% of oxygen (O2) to the CO2 PP, the aim of this study was to evaluate the effect of adding 4% O2 to the CO2 PP on mesothelial cell morphology.
Methods
In a standardized laparoscopic mouse model (n=8 mice per group), a control group with
a 30- or 60-min PP with humidified CO2 + 4% of O2 (groups I and II) was compared to a hypoxic group with 30- or 60-min humidified pure
CO2 (groups III and IV) and a desiccation group with 60-min of dry CO2 PP (group V). The effect upon the peritoneum morphology was evaluated by scanning
electron microscopy (SEM) of abdominal wall peritoneal biopsies. Biopsies, taken immediately
(n=4) and 24 hrs (n=4) after surgery, were compared to a group without PP (group VI,
n=4). SEM pictures were blindly scored for cell retraction, deletion of microvilli,
fibrin deposition, holes in the epithelial layer and visibility of cell borders using
a semi-quantitative scoring system.
Results
PP Hypoxia (CO2 PP) has a deleterious effect upon mesothelial morphology, immediately (holes: p= 0.04)
and 24 hrs later (cell retraction: p=0.005; total score: p=0.03) . Desiccation has
also a deleterious effect immediately (microvilli p=0.0090; fibrin deposition p=0.05)
and 24 hrs after surgery (cell retraction: p=0.0036; holes: p=0.0004; microvilli:
p< 0.0001, fibrin deposition: p=0.0225; borders: p=0.0007). This deleterious effect
increases with duration of CO2 PP, affecting cell retraction (p=0.016), holes (p=0.0441), and the total score (p=0.0488).
The addition of 4% of O2 to the CO2 PP failed to reach statistical significance.
Conclusions
These data confirm that CO2 PP and dry gas have a deleterious effect on mesothelial cell morphology. Humidification
of the insufflation gas reduces this deleterious effect. The hypothesis of a protective
effect of adding O2 failed to reach significance.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Humidification during laparoscopic surgery: overview of the clinical benefits of using humidified gas during laparoscopic surgery.Arch Gynecol Obstet. 2015; 292: 955-971https://doi.org/10.1007/s00404-015-3717-y
- Peritoneal mesothelial hypoxia during pneumoperitoneum is a cofactor in adhesion formation in a laparoscopic mouse model.Fertil Steril. 2001; 76: 560-567https://doi.org/10.1016/S0015-0282(01)01964-1
- Postoperative inflammation in the abdominal cavity increases adhesion formation in a laparoscopic mouse model.Fertil Steril. 2011; 95: 1224-1228https://doi.org/10.1016/j.fertnstert.2011.01.004
- Effect of adding more than 3% oxygen to carbon dioxide pneumoperitoneum on adhesion formation in a laparoscopic mouse model.Fertil Steril. 2004; 82: 1616-1622https://doi.org/10.1016/j.fertnstert.2004.07.933
- Role of hypoxia inducible factors 1α and 2α in basal adhesion formation and in carbon dioxide pneumoperitoneum-enhanced adhesion formation after laparoscopic surgery in transgenic mice.Fertil Steril. 2003; 80: 795-802https://doi.org/10.1016/S0015-0282(03)00779-9
- Efficacy of barriers and hypoxia-inducible factor inhibitors to prevent CO2 pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model.J Minim Invasive Gynecol. 2007; 14https://doi.org/10.1016/j.jmig.2007.04.002
- Pharmacological HIF-inhibition attenuates postoperative adhesion formation.Sci Rep. 2017; 7https://doi.org/10.1038/s41598-017-13638-z
- The biology of adhesion formation in the peritoneal cavity.Semin Pediatr Surg. 2014; 23: 336-343https://doi.org/10.1053/j.sempedsurg.2014.06.004
- Effect of desiccation and temperature during laparoscopy on adhesion formation in mice.Fertil Steril. 2006; 86: 166-175https://doi.org/10.1016/j.fertnstert.2005.11.079
- Characteristic alterations of the peritoneum after carbon dioxide pneumoperitoneum.Surg Endosc. 1999; 13: 611-614https://doi.org/10.1007/s004649901052
- Morphology of the murine peritoneum after pneumoperitoneum vs laparotomy.Surg Endosc. 2001; 15: 954-958https://doi.org/10.1007/s004640090100
- Electron-microscopic alterations of the peritoneum after both cold and heated carbon dioxide pneumoperitoneum.J Surg Res. 2005; 125: 73-77https://doi.org/10.1016/j.jss.2004.11.029
- Heated and Humidified CO2 Prevents Hypothermia, Peritoneal Injury, and Intra-Abdominal Adhesions During Prolonged Laparoscopic Insufflations.J Surg Res. 2009; 151: 40-47https://doi.org/10.1016/j.jss.2008.03.039
- Effect of carbon dioxide pneumoperitoneum during laparoscopic surgery on morphology of peritoneum.Natl Med J China. 2006; 86
Binda MM, Molinas CR, Mailova K, Koninckx PR. Effect of temperature upon adhesion formation in a laparoscopic mouse model. Hum Reprod 2004;19. https://doi.org/10.1093/humrep/deh495.
- Hypoxaemia induced by CO2 or helium pneumoperitoneum is a co-factor in adhesion formation in rabbits.Hum Reprod. 2000; 15https://doi.org/10.1093/humrep/15.8.1758
- Role of vascular endothelial growth factor and placental growth factor in basal adhesion formation and in carbon dioxide pneumoperitoneum-enhanced adhesion formation after laparoscopic surgery in transgenic mice.Fertil Steril. 2003; 80: 803-811https://doi.org/10.1016/S0015-0282(03)00768-4
- N2O strongly prevents adhesion formation and postoperative pain in open surgery through a drug-like effect.Gynecol Surg. 2017; 14https://doi.org/10.1186/s10397-017-1024-2
- Does CO2 Pneumoperitoneum Alter the Ultra-Structuture of the Mesothelium?.J Surg Res. 2006; 133: 84-88https://doi.org/10.1016/j.jss.2005.09.032
- Impact of temperature and humidity of carbon dioxide pneumoperitoneum on body temperature and peritoneal morphology.J Laparoendosc Adv Surg Tech - Part A. 2002; 12: 355-364https://doi.org/10.1089/109264202320884108
- Factorial designs. Statistical methods in medical research.Blackwell Scientific Publications, Oxford, UK1987
- Addition of nitrous oxide to the carbon dioxide pneumoperitoneum strongly decreases adhesion formation and the dose-dependent adhesiogenic effect of blood in a laparoscopic mouse model.Fertil Steril. 2013; 100: 1777-1783https://doi.org/10.1016/j.fertnstert.2013.08.049
- Murine host response to Neisseria gonorrhoeae upper genital tract infection reveals a common transcriptional signature, plus distinct inflammatory responses that vary between reproductive cycle phases.BMC Genomics. 2018; 19https://doi.org/10.1186/s12864-018-5000-7
- Sex-specific microRNA expression networks in an acute mouse model of ozone-induced lung inflammation.Biol Sex Differ. 2018; 9https://doi.org/10.1186/s13293-018-0177-7
- Modulation of the lung inflammatory response to ozone by the estrous cycle.Physiol Rep. 2019; 7: e14026https://doi.org/10.14814/phy2.1402610.21203/rs.2.15141/v1
Article info
Publication history
Published online: August 21, 2021
Accepted:
August 19,
2021
Received in revised form:
July 3,
2021
Received:
April 6,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
