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Morphology of the murine peritoneum after pneumoperitoneum vs laparotomy
T Suematsu1, Y Hirabayashi, N Shiraishi
1Department of Surgery I, Oita Medical University, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan.
Background:
Although there have been studies of the effects of pneumoperitoneum on the peritoneal cavity, we still do not know whether the morphologic changes to the peritoneum are different for pneumoperitoneum vs laparotomy. Using scanning electron microscopy, we examined the murine peritoneum after pneumoperitoneum vs laparotomy and compared the changes.
Methods:
Forty-five mice were anesthetized with diethyl ether and divided into seven groups. Pneumoperitoneum was established at 5 mmHg for 30 min with carbon dioxide (CO(2)) (n = 9), helium (n = 9), and air (n = 9). One group underwent laparotomy for 30 min (n = 9), and a control group underwent anesthesia only (n = 3). CO(2) pneumoperitoneum was further established at 10 mmHg for 30 min (n = 3) and at 5 mmHg for 60 min (n = 3). After the procedures, the peritoneum was resected from the mesenterium of the small intestine in each animal and examined by scanning electron microscope for morphologic changes of the mesothelial cells.
Results:
Bulging up of the mesothelial cells was evident immediately after pneumoperitoneum, whereas detachment of the mesothelial cells was present immediately after laparotomy. Bulging up of the mesothelial cells was reduced at 24 h after CO(2) pneumoperitoneum and fully resolved at 72 h in all pneumoperitoneum groups, whereas the mesothelial cells remained detached at 72 h in the laparotomy group. Intercellular clefts were found immediately after helium pneumoperitoneum and were present at 24 h and 72 h after helium pneumoperitoneum, but they were not seen after air pneumoperitoneum and were only evident after CO(2) pneumoperitoneum at 10 mmHg. Depression of the mesothelial cell surface was observed when pneumoperitoneum lasted 60 min.
Conclusion:
Morphologic peritoneal alterations after pneumoperitoneum differed from those after laparotomy and were influenced by the type of gas, amount of pressure, and duration of insufflation. These peritoneal changes after pneumoperitoneum may be associated with a specific intraperitoneal tumor spread after laparoscopic cancer surgery.
Insights
Pneumoperitoneum causes different peritoneal changes than laparotomy, varying with gas type, pressure, and duration. These findings may impact tumor spread in laparoscopic surgery.
Area of Science:
- Surgical Innovation
- Gastroenterology
- Cell Biology
Background:
- Peritoneal cavity changes from pneumoperitoneum are not fully understood compared to laparotomy.
- Morphologic differences in the peritoneum between pneumoperitoneum and laparotomy require investigation.
Purpose of the Study:
- To compare the morphologic changes to the murine peritoneum after pneumoperitoneum versus laparotomy.
- To investigate the influence of gas type, pressure, and duration on peritoneal changes during pneumoperitoneum.
Main Methods:
- Scanning electron microscopy was used to examine the murine peritoneum.
- Mice underwent pneumoperitoneum (CO2, helium, air) or laparotomy at varying pressures and durations.
- Mesothelial cell morphologic changes were assessed post-procedure.
Main Results:
- Pneumoperitoneum caused mesothelial cell bulging, resolving within 72 hours, while laparotomy caused cell detachment persisting at 72 hours.
- Helium pneumoperitoneum induced intercellular clefts, while CO2 at 10 mmHg also showed clefts.
- Prolonged pneumoperitoneum (60 min) resulted in mesothelial cell surface depression.
Conclusions:
- Peritoneal morphologic alterations differ significantly between pneumoperitoneum and laparotomy.
- Gas type, pressure, and insufflation duration influence peritoneal changes during pneumoperitoneum.
- These peritoneal changes may be relevant to intraperitoneal tumor spread in laparoscopic cancer surgery.