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      The Effects of Insufflation Conditions on Rat Mesothelium

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          Abstract

          Aim. The aim of this investigation was to examine the alterations in the peritoneum after cold dry CO 2, heated dry CO 2, and humidified heated CO 2 at pressures equivalent to intraperitoneal pressures used in human laparoscopy. Methods. Eighteen rats were divided into 4 treatment groups—group 1: untreated control; group 2: insufflation with cold dry CO 2; group 3: insufflation with heated, dry CO 2; group 4: insufflation with heated and humidified CO 2. The abdomen was insufflated to 5 mm/Hg (flow rate 50 mL/min) for 2 h. Twelve hours later, tissue samples were collected for analysis by light microscopy (LM) and scanning electron microscopy (SEM). Results. Group 1: no abnormalities were detected. Group 2: specimens revealed an inflammatory response with loss of mesothelium and mesothelial cell nuclei showing lytic change. Cells were rounded with some areas of cell flattening and separation. Group 3: some animals showed little or no alteration, while others had a mild inflammatory response. Mesothelial cells were rounded and showed crenation on the exposed surface. Group 4: specimens showed little change from the control group. Conclusions. The LM results indicate that insufflations with heated, humidified CO 2 are the least likely to induce mesothelial damage.

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          Most cited references39

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          Peritoneal repair and post-surgical adhesion formation.

          It was shown in 1919 that peritoneal healing differs from that of skin. When a defect is made in the parietal peritoneum the entire surface becomes epithelialized simultaneously and not gradually from the borders as in epidermalization of skin wounds. While multiplication and migration of mesothelial cells from the margin of the wound may play a small part in the regenerative process, it cannot play a major role, since new mesothelium develops in the centre of a large wound at the same time as it develops in the centre of a smaller one. Development of intraperitoneal adhesions is a dynamic process whereby surgically traumatized tissues in apposition bind through fibrin bridges which become organized by wound repair cells, often supporting a rich vascular supply as well as neuronal elements.
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            Does post-laparoscopy pain relate to residual carbon dioxide?

            We studied 20 day case gynaecological laparoscopy patients, who had an erect chest X ray taken before discharge. Patients were telephoned the next day for a semi-structured interview. Particular note was made of shoulder tip pain and pain relieved by changing posture. The X ray was analysed for measurements of the length of arc and height of the gas bubble under each hemi-diaphragm, from which an estimation of bubble volume was also made. We found statistically significant correlations between both the length of arc (p = 0.005) and volume of gas bubble (p = 0.008) on the right side, with the pain score. Residual gas can be a prominent cause of post-laparoscopy pain.
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              Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations.

              Insufflation with standard cold-dry CO(2) during laparoscopic surgery has been shown to predispose patients to hypothermia and peritoneal injury. This study aimed to compare the effect of prolonged cold-dry CO(2) insufflation with heated-humidified CO(2) insufflation (3-5 h) on hypothermia, peritoneal damage, and intra-abdominal adhesion formation in a rat model. A total of 160 Wistar rats were randomized to undergo no insufflation or insufflation with cold-dry CO(2) (21 degrees C, <1% relative humidity) or heated-humidified CO(2) (37 degrees C, 95% relative humidity) for 3, 4, or 5 h. Core body temperature was measured via rectum before and during insufflations. Peritoneal samples were taken at 6, 24, 48, and 96 h after treatments and analyzed with light microscopy and scanning electron microscopy. Intra-abdominal adhesions were evaluated 2 weeks later. Core body temperature significantly decreased in the cold-dry group, whereas it was maintained and increased in the heated-humidified group. Scanning electron microscopy and light microscopy studies showed intense peritoneal injury in the cold-dry CO(2) group but significantly less damages in the heated-humidified group. Increased intra-abdominal adhesion formation was observed in the cold-dry CO(2) group, while no adhesions were found in the rats insufflated with heated-humidified CO(2). Heated-humidified CO(2) insufflation results in significantly less hypothermia, less peritoneal damage, and decreased adhesion formation as compared with cold-dry CO(2) insufflation. Heated-humidified CO(2) may be more suitable for insufflation application in prolonged laparoscopic surgery.
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                Author and article information

                Journal
                Int J Inflam
                Int J Inflam
                IJI
                International Journal of Inflammation
                Hindawi Publishing Corporation
                2090-8040
                2042-0099
                2013
                24 June 2013
                : 2013
                : 816283
                Affiliations
                1Research Centre for the Molecular Basis of Disease, Griffith Health Institute, Griffith University, Gold Coast, QLD 4222, Australia
                2School of Pharmacy and Medical Science, University of South Australia, Adelaide, SA 5001, Australia
                3Fisher & Paykel Healthcare Limited, 15 Maurice Paykel Road, East Tamaki, Auckland 2013, New Zealand
                4Graduate School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia
                Author notes

                Academic Editor: G. Rogler

                Author information
                http://orcid.org/0000-0002-3140-1048
                Article
                10.1155/2013/816283
                3707227
                23864985
                baceda94-67fb-4237-b238-8602ba351b05
                Copyright © 2013 Andrew K. Davey et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 March 2013
                : 11 June 2013
                : 11 June 2013
                Categories
                Research Article

                Immunology
                Immunology

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