Heating of carbon dioxide during insufflation alters the peritoneal fibrinolytic response to laparoscopic surgery: A clinical trial

W. J A Brokelman, L. Holmdahl, M. Bergström, P. Falk, J. H G Klinkenbijl, M. M P J Reijnen

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1232-1236
Number of pages5
JournalSurgical Endoscopy and Other Interventional Techniques
Volume22
Issue number5
DOIs
Publication statusPublished - 1 May 2008
Externally publishedYes

Keywords

  • Carbon dioxide
  • Laparoscopic surgery
  • Peritoneum
  • Plasmin system
  • Plasminogen activator inhibitor type-1
  • Pneumoperitoneum
  • Temperature
  • Tissue type plasminogen activator
  • Urokinase type activator

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