Heating of carbon dioxide during insufflation alters the peritoneal fibrinolytic response to laparoscopic surgery : A clinical trial.
BACKGROUND
Laparoscopic surgery is evolving rapidly. It involves the creation of a pneumoperitoneum, mostly using carbon dioxide. Cooling of the peritoneum, due to insufflation, might traumatize the peritoneum and disturb peritoneal fibrinolysis, important in peritoneal healing processes. The current study was performed to elucidate the effects of the temperature of insufflation gas on the peritoneal fibrinolytic response to laparoscopic surgery.


METHODS
Thirty patients scheduled for laparoscopic cholecystectomy were randomized in two groups: one group in which the pneumoperitoneum was created with carbon dioxide at room temperature, and one wherein carbon dioxide at body temperature was used. Peritoneal biopsies were taken at the start and at the end of surgery. Tissue concentrations of tPA antigen, tPA activity, uPA antigen, and PAI-1 antigen were measured using ELISA techniques.


RESULTS
Peritoneal PAI-1 antigen levels were significantly higher at the end of the procedure in patients operated with carbon dioxide at room temperature (p < .05). A slight, but not significant, decrease in tPA antigen and activity was observed in both groups during the procedure. Peritoneal concentrations of uPa antigen did not change during the procedure.


CONCLUSIONS
The temperature of carbon dioxide used for insufflation of the abdominal cavity affects peritoneal biology. Cooling of the peritoneum by unheated carbon dioxide causes increased peritoneal PAI-1 levels, important in peritoneal healing processes.
Brokelman
W J A
WJ
Department of Surgery, Alysis Zorggroep, Locatie Rijnstate, Wagnerlaan 55, 6815, AD, Arnhem, The Netherlands. w.brokelman@planet.nl
Holmdahl
L
L
Bergström
M
M
Falk
P
P
Klinkenbijl
J H G
JH
Reijnen
M M P J
MM
D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000008:administration & dosage*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005342:Fibrinolysis; D006358:Hot Temperature / Q000627:therapeutic use*; D006801:Humans; D007327:Insufflation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D017395:Plasminogen Activator Inhibitor 1 / Q000378:metabolism; D019396:Tissue Polypeptide Antigen / Q000187:drug effects / Q000378:metabolism; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000187:drug effects / Q000378:metabolism
D017395:Plasminogen Activator Inhibitor 1; D019396:Tissue Polypeptide Antigen; D002245:Carbon Dioxide; D014568:Urokinase-Type Plasminogen Activator