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Pneumoperitoneum induced mesothelial cell changes in a laparoscopic mouse model.

Maria Mercedes Binda1, Mads Riiskjaer1, Philippe Robert Koninckx1

  • 1Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven (KULeuven), Leuven, Belgium.

European Journal of Obstetrics, Gynecology, and Reproductive Biology
|September 5, 2021
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Summary

Carbon dioxide pneumoperitoneum (PP) during laparoscopic surgery damages mesothelial cells. Humidification helps, but adding oxygen to CO2 PP did not significantly protect these cells.

Keywords:
CO(2) pneumoperitoneum +4% oxygenLaparoscopyMesothelial traumaPeritoneumPostoperative adhesionselectron microscopy

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Area of Science:

  • Laparoscopic surgery
  • Cell biology
  • Surgical complications

Background:

  • Carbon dioxide pneumoperitoneum (CO2 PP) in laparoscopic surgery can lead to hypoxia and desiccation of peritoneal mesothelial cells.
  • This cellular damage results in time-dependent retraction, inflammation, and increased adhesion formation.
  • Adding oxygen to CO2 PP is a potential strategy to mitigate hypoxia.

Purpose of the Study:

  • To investigate the impact of adding 4% oxygen to CO2 pneumoperitoneum on mesothelial cell morphology.
  • To compare the effects of hypoxia, desiccation, and humidified CO2 PP on peritoneal tissues.

Main Methods:

  • A standardized laparoscopic mouse model was used with different insufflation gases (CO2 + 4% O2, pure CO2, dry CO2) and durations (30-60 minutes).
  • Peritoneal morphology was assessed using scanning electron microscopy (SEM) on biopsies taken immediately and 24 hours post-surgery.
  • SEM images were scored for specific morphological changes like cell retraction, microvilli deletion, and fibrin deposition.

Main Results:

  • CO2 PP, particularly under hypoxic conditions, caused significant mesothelial cell damage, including holes and cell retraction, both immediately and 24 hours post-surgery.
  • Desiccation also led to significant morphological damage, affecting microvilli, fibrin deposition, and cell borders.
  • The detrimental effects worsened with longer CO2 PP duration, but the addition of 4% oxygen did not yield statistically significant protective effects.

Conclusions:

  • CO2 pneumoperitoneum and dry insufflation gas negatively impact mesothelial cell morphology.
  • Humidifying the insufflation gas can mitigate some of these adverse effects.
  • The addition of 4% oxygen to CO2 pneumoperitoneum did not demonstrate a significant protective effect on mesothelial cell morphology in this study.