Helium gas pneumoperitoneum can improve the recovery of gastrointestinal motility after a laparoscopic operation

Are Smoke and Aerosols Generated During Laparoscopic Surgery a Biohazard? A Systematic Evidence-Based Review

Background. Laparoscopic surgery generates end products that can have potentially harmful effects for the surgical team from short- or long-time exposure. In view of the current SARS-CoV-2 circumstances, controversy has risen concerning the safety of surgical smoke (SS) and aerosols and the perception of an increased risk of exposure during laparoscopic surgery. Methods. The present qualitative systematic review was conducted according to Meta-Analyses and Systematic Reviews of Observational Studies (MOOSE). A literature search was performed from March 2020 up to May 10, 2020, using the PubMed database, Cochrane, and Google Scholar to assess the risk of airborne transmission of viruses and the potential health risk of surgical smoke- and aerosol-generating procedures produced during laparoscopic surgery. The keywords were introduced in combination to obtain better search results. Application of the inclusion and exclusion criteria identified 44 relevant articles. Results. Genetic material from certain viruses, or the virus itself, has been detected in SS and aerosols. However, in the current SARS-CoV-2, as in other coronavirus situations, studies analyzing the presence of airborne transmission of viruses in surgical smoke are lacking. Conclusion. Despite the lack of clear evidence regarding the risk of diseases as the result of smoke- and aerosol-generating procedures during laparoscopic surgery, further investigation is needed. Meanwhile, all available precautions must be taken.

The role of helium gas in medicine

The noble gas helium has many applications owing to its distinct physical and chemical characteristics, namely: its low density, low solubility, and high thermal conductivity. Chiefly, the abundance of studies in medicine relating to helium are concentrated in its possibility of being used as an adjunct therapy in a number of respiratory ailments such as asthma exacerbation, COPD, ARDS, croup, and bronchiolitis. Helium gas, once believed to be biologically inert, has been recently shown to be beneficial in protecting the myocardium from ischemia by various mechanisms. Though neuroprotection of brain tissue has been documented, the mechanism by which it does so has yet to be made clear. Surgeons are exploring using helium instead of carbon dioxide to insufflate the abdomen of patients undergoing laparoscopic abdominal procedures due to its superiority in preventing respiratory acidosis in patients with comorbid conditions that cause carbon dioxide retention. Newly discovered applications in Pulmonary MRI radiology and imaging of organs in very fine detail using Helium Ion Microscopy has opened exciting new possibilities for the use of helium gas in technologically advanced fields of medicine.

Esophageal and gastric smooth muscle activity after carbon dioxide pneumoperitoneum

BACKGROUND

The metabolic changes associated with carbon dioxide (CO(2)) pneumoperitoneum include metabolic acidosis and lowered intra-abdominal pH values. An experimental study was performed to evaluate the effect of CO(2) pneumoperitoneum on esophageal and gastric smooth muscle sensitivity in response to several agonists.

METHODS

Wistar albino rats, weighing 200-250 g, were allocated into three groups. After anesthetization with ketamine hydrochloride and xylazine, abdominal esophagus, gastroesophageal junction, and gastric fundus were removed via median laparotomy in the control group. In the oxygen (O(2)) group, a 16G catheter was inserted into the abdomen above the umbilicus and insufflated with 95% O(2) and 5% CO(2) with a pressure of 10 mm Hg. In the CO(2) group, CO(2) was insufflated at the same pressure within the same time and the tissues were removed at the end of a 60 min period of pneumoperitoneum. Abdominal esophageal segment (n:6), gastroesophageal junction (n:6) and gastric fundus (n:12) were suspended under 0.5 to 2 g resting tension in Tyrode solution in organ baths. Contraction responses were obtained by carbachol and serotonin and relaxation responses were evaluated by isoproterenol in each group. All the responses were compared by nonparametric Kruskal Wallis test.

RESULTS

Carbachol and serotonin induced contractile responses of abdominal segments, gastroesophageal junction, and gastric fundus showed no difference between the control, O(2), and CO(2) groups (P > 0.05). Isoproterenol relaxation responses of the three groups were also not statistically different from each other (P > 0.05).

CONCLUSION

CO(2) pneumoperitoneum of 60 min has no influence on esophageal and gastric smooth muscle responses to different agonists in rats.