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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.
Background:
CO2 pneumoperitoneum (PP) during laparoscopic surgery, can cause hypoxia and desiccation in the peritoneal mesothelial cell, resulting in a time-dependent retraction and bulging of these cells, an acute inflammatory reaction and enhanced adhesion formation. Since hypoxia is prevented by adding 4% of oxygen (O2) to the CO2 PP, the aim of this study was to evaluate the effect of adding 4% O2 to the CO2 PP on mesothelial cell morphology.
Methods:
In a standardized laparoscopic mouse model (n=8 mice per group), a control group with a 30- or 60-min PP with humidified CO2 + 4% of O2 (groups I and II) was compared to a hypoxic group with 30- or 60-min humidified pure CO2 (groups III and IV) and a desiccation group with 60-min of dry CO2 PP (group V). The effect upon the peritoneum morphology was evaluated by scanning electron microscopy (SEM) of abdominal wall peritoneal biopsies. Biopsies, taken immediately (n=4) and 24 hrs (n=4) after surgery, were compared to a group without PP (group VI, n=4). SEM pictures were blindly scored for cell retraction, deletion of microvilli, fibrin deposition, holes in the epithelial layer and visibility of cell borders using a semi-quantitative scoring system.
Results:
PP Hypoxia (CO2 PP) has a deleterious effect upon mesothelial morphology, immediately (holes: p= 0.04) and 24 hrs later (cell retraction: p=0.005; total score: p=0.03) . Desiccation has also a deleterious effect immediately (microvilli p=0.0090; fibrin deposition p=0.05) and 24 hrs after surgery (cell retraction: p=0.0036; holes: p=0.0004; microvilli: p< 0.0001, fibrin deposition: p=0.0225; borders: p=0.0007). This deleterious effect increases with duration of CO2 PP, affecting cell retraction (p=0.016), holes (p=0.0441), and the total score (p=0.0488). The addition of 4% of O2 to the CO2 PP failed to reach statistical significance.
Conclusions:
These data confirm that CO2 PP and dry gas have a deleterious effect on mesothelial cell morphology. Humidification of the insufflation gas reduces this deleterious effect. The hypothesis of a protective effect of adding O2 failed to reach significance.
Insights
Carbon dioxide pneumoperitoneum (PP) during laparoscopic surgery damages mesothelial cells. Humidification helps, but adding oxygen to CO2 PP did not significantly protect these cells.
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.
