Acute recovery of pneumoperitoneum using argon gas

The argon-beam coagulator (ABC) is widely used in laparoscopic surgery as a method of electrocoagulation. Argon gas possesses properties that make it suitable as an alternative for establishing pneumoperitoneum. We present a case in which an ABC was used to deliver argon gas urgently in order to salvage an acutely compromised pneumoperitoneum.

During a right partial nephrectomy, after the renal artery was clamped, a failure in the central CO(2) compressor compromised the pneumoperitoneum. Argon gas was delivered from an ABC at a flow rate of 4 L/min and a distance of 1 to 5 cm and directed toward the paranephric fat.

Pneumoperitoneum was rapidly reestablished. Stable intra-abdominal pressure was maintained in the range of 14 to 20 mm Hg for 16 minutes until the original CO(2) supply was reestablished. The total warm ischemia time was 32 minutes. No hemodynamic changes were noted while using argon gas, and the procedure was completed successfully with an uneventful postoperative course.

Argon gas delivery from an ABC can be used for emergency salvage of pneumoperitoneum in selected cases of acute CO(2) gas delivery failure and under strict intra-abdominal pressure monitoring.