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Warmed and humidified carbon dioxide for abdominal laparoscopic surgery: meta-analysis of the current literature

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An Erratum to this article was published on 29 December 2016

Abstract

Background

The creation of a pneumoperitoneum for laparoscopic surgery is performed by the insufflation of carbon dioxide (CO2). The insufflated CO2 is generally at room temperature (20–25 °C) and dry (0–5 % relative humidity). However, these physical characteristics could lead to alterations of the peritoneal cavity, leading to operative and postoperative complications. Warming and humidifying the insufflated gas has been proposed to reduce the iatrogenic effects of laparoscopic surgery, such as pain, hypothermia and peritoneal alterations. Two medical devices are currently available for laparoscopic surgery with warm and humidified CO2.

Methods

Clinical studies were identified by searching PubMed with keywords relating to humidified and warmed CO2 for laparoscopic procedures. Analysis of the literature focused on postoperative pain, analgesic consumption, duration of hospital stay and convalescence, surgical techniques and hypothermia.

Results

Bibliographic analyses reported 114 publications from 1977 to 2015, with only 17 publications of clinical interest. The main disciplines focused on were gynaecological and digestive surgery ). Analysis of the studies selected reported only a small beneficial effect of warmed and humidified laparoscopy compared to standard laparoscopy on immediate postoperative pain and per procedure hypothermia. No difference was observed for later postoperative shoulder pain, morphine equivalent daily doses, postoperative body core temperature, recovery room and hospital length of stay, lens fogging and procedure duration.

Conclusions

Only few beneficial effects on immediate postoperative pain and core temperature have been identified in this meta-analysis. Although more studies are probably needed to close the debate on the real impact of warmed and humidified CO2 for laparoscopic procedures.

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Authors and Affiliations

  1. Délégation à la Recherche Clinique et à l’Innovation, CHU de Clermont-Ferrand, Villa annexe IFSI, 58, rue Montalembert, 63003, Clermont-Ferrand Cedex, France

    David Balayssac, Bruno Pereira, Jean-Etienne Bazin & Denis Pezet

  2. Faculté de Médecine et de Pharmacie, Clermont Université, 63001, Clermont-Ferrand, France

    David Balayssac, Jean-Etienne Bazin & Denis Pezet

  3. INSERM, U1107, 63000, Clermont-Ferrand, France

    David Balayssac

  4. Anesthésie Réanimation, CHU de Clermont-Ferrand, 63058, Clermont-Ferrand, France

    Jean-Etienne Bazin

  5. Chirurgie Digestive, CHU de Clermont-Ferrand, 63058, Clermont-Ferrand, France

    Bertrand Le Roy, Denis Pezet & Johan Gagnière

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  1. David Balayssac
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  2. Bruno Pereira
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Correspondence to David Balayssac.

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Prof. Denis Pezet, Prof. Jean-Etienne Bazin, Dr. David Balayssac, Dr. Bruno Pereira, Dr. Bertrand Le Roy and Dr. Johan Gagnière have no conflicts of interest or financial ties to disclose.

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An erratum to this article is available at http://dx.doi.org/10.1007/s00464-016-5335-6.

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Balayssac, D., Pereira, B., Bazin, JE. et al. Warmed and humidified carbon dioxide for abdominal laparoscopic surgery: meta-analysis of the current literature. Surg Endosc 31, 1–12 (2017). https://doi.org/10.1007/s00464-016-4866-1

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