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Intraperitoneal cell movement during abdominal carbon dioxide insufflation and laparoscopy. An in vivo model
P J Hewett1, W M Thomas, G King
1Department of Surgery, Queen Elizabeth Hospital, Woodville, Australia.
Purpose:
Possible mechanisms of movement of malignant cells within the peritoneal cavity during CO2 insufflation and laparoscopy involve direct transfer via laparoscopic instruments or dispersion of cells by CO2 or water vapor. An in vivo model has been developed to study these mechanisms.
Methods:
Laparoscopy was performed on an animal model (domestic white pig). Cells derived from colorectal cancer cell line Lim 1215 were injected to lie free within the peritoneal cavity. A polycarbonate filter system with a 5-micron pore diameter was used to examine CO2 expelled from the peritoneal cavity, during laparoscopy and manipulation of abdominal viscera, for malignant cells. Laparoscopic instruments and laparoscopic ports were washed independently, and fluid was centrifuged and examined for malignant cells.
Results:
Malignant cells were identified on 1 of 30 filters used to examine exhaust carbon dioxide. Malignant cells also were identified from 2 of 10 washings from laparoscopic ports and from 4 of 10 washings of laparoscopic instruments.
Conclusions:
These results suggest that movement of cells throughout the peritoneal cavity during laparoscopy is via contaminated instruments, but local cell movement by dispersion possibly within water vapor from the port may also occur.