title: Effect of carbon dioxide pneumoperitoneum on tissue blood flow in the peritoneum, rectus abdominis, and diaphragm muscles.
abstract: BACKGROUND
  Changes in local blood flow may play a role in the pathogenesis of port-site metastasis. This study aimed to investigate the effect of pneumoperitoneum induced by carbon dioxide (CO2) on the blood flow in the peritoneum and abdominal wall muscle layers, which are target structures for this phenomenon.
  
  
  METHODS
  The study was performed on domestic farm swine of both genders weighing 20 to 25 kg. Intraabdominal pressures (IAP) of 0, 5, and 10 mmHg were produced by either CO2 ( n = 9) or helium (He) ( n = 6) insufflations. The colored microsphere technique was used to measure blood flow distributions in the parietal peritoneum, rectus abdominis, and diaphragm muscles.
  
  
  RESULTS
  Insufflation of CO2 was associated with a threefold increase in blood flow of the parietal peritoneum at both 5 and 10 mmHg IAP ( p < 0.001 for both pressure levels). In contrast, insufflation of He caused a significant decrease in blood flow in the parietal peritoneum at both 5 and 10 mmHg ( p < 0.05). In the rectus abdominis and diaphragm muscles, blood flow remained unchanged after insufflation of CO2 at both 5 and 10 mmHg IAP. However, after insufflation of He, there was a substantial decrease in blood flow both in the rectus abdominis and diaphragm muscles at both 5 mmHg ( p < 0.01 and p < 0.05, respectively) and 10 mmHg ( p < 0.001 and p < 0.01, respectively).
  
  
  CONCLUSIONS
  Despite high intraabdominal pressure, tissues surrounding the abdominal cavity, particularly the peritoneum, respond to insufflation of CO2 with increased blood flow, which may favor the growth of tumor cells.
authors.affiliation: National Center for Advanced Laparoscopic Surgery, St. Olav University Hospital, N-7006, Trondheim, Norway. nsalk@online.no
authors.forename: Y
authors.initials: Y
authors.lastname: Yavuz
authors.forename: K
authors.initials: K
authors.lastname: Rønning
authors.forename: O
authors.initials: O
authors.lastname: Lyng
authors.forename: J E
authors.initials: JE
authors.lastname: Grønbech
authors.forename: R
authors.initials: R
authors.lastname: Mårvik
mesh_terms: D000818:Animals; D002245:Carbon Dioxide; D002408:Catheters, Indwelling / Q000009:adverse effects; D003964:Diaphragm / Q000098:blood supply*; D005260:Female; D006371:Helium; D008297:Male; D010537:Peritoneum / Q000098:blood supply*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D017568:Rectus Abdominis / Q000098:blood supply*; D012039:Regional Blood Flow; D013552:Swine
chemical_list: D002245:Carbon Dioxide; D006371:Helium