Hurdles to helium gas laparoscopy and a readily available alternative

Although multiple series of helium insufflation-assisted laparoscopic surgery are reported, we encountered difficulty at many levels when arranging a laparoscopic nephrectomy with helium insufflation. We present our experience with attempting to use helium gas as an insufflant and our successful use of argon gas as an adjunct to CO(2) insufflation with a case report as illustration.

The patient is a 66-year-old man with a progressively enlarging 3.1-cm right renal mass. His history is significant for severe chronic obstructive pulmonary disease, necessitating home oxygen and frequent cycles of steroids. In line with the patient's desire for a minimally invasive procedure, we scheduled a laparoscopic nephrectomy with helium gas. Helium tanks need specialized adapters (yoke) to connect to laparoscopic insufflators; once the yoke was located, we were informed that helium is not approved by the Food and Drug Administration for use as an insufflant and we could not proceed with its use without a full hospital institutional review board review. We elected to use low-pressure CO(2) insufflation augmented by argon gas insufflation via the argon beam coagulator.

The patient tolerated the low-pressure CO(2) /argon gas pneumoperitoneum without difficulty. There were no significant changes in the hemodynamic variables throughout the procedure. This patient was extubated at the completion of the procedure, and there were no intraoperative or postoperative complications.

Although numerous reports and case series exist regarding the use of helium as an alternate insufflation agent to CO(2), the logistics of obtaining the correct helium yoke and hospital approval are cumbersome for this rarely indicated agent. A far simpler alternative, with similar physiologic effects, is the use of argon gas as an adjunct to CO(2) insufflation, or in lieu of CO(2) insufflation.