Measurement of CO(2) hypothermia during laparoscopy and pelviscopy: how cold it gets and how to prevent it

STUDY OBJECTIVE

To evaluate intraabdominal CO(2) temperature during a variety of standard operative laparoscopy procedures with different insufflators (BEI Medical, Snowden & Pencer, Storz Laparoflator, Storz Endoflator, Wolf) and devices to maintain body temperature (Bair Hugger, fluid warmer, Blanketrol blankets).

DESIGN

Prospective, nonrandomized study (Canadian Task Force classification II-1).

SETTING

Community hospital in rural Alabama.

PATIENTS

Sixty-two consecutive patients (53 women, 9 men; average age 56.8 yrs, range 21-94 yrs).

INTERVENTIONS

Patients underwent standard laparoscopic and pelviscopic procedures during which intraoperative temperature changes in the insufflation system, abdomen, and rectum were measured.

MEASUREMENTS AND MAIN RESULTS

Carbon dioxide was at room temperature in the insufflation hose ( approximately 23 degrees C). During insufflation, intraabdominal gas temperature decreased to as much as 27.7 degrees C (average 32.7 degrees C) depending on length of operation (23 min-5 hrs 8 min), amount of gas used (12.8-801 L), gas flow (up to 20 L/min), and leakage rate. Preoperative and postoperative temperature comparisons showed no decline in rectal temperature (average +0.18 degrees C) because warming equipment was sufficient.

CONCLUSION

The decrease in intraoperative intraabdominal gas temperature is remarkable and can potentially harm the patient. It can be limited by restricting gas flow and leakage. In operations longer than 1 hour, substantial core body temperature drop should be prevented with appropriate heating and hydration devices. An insufflator with internal gas heating (Snowden & Pencer) had no significant clinical effect. (J Am Assoc Gynecol Laparosc 6(3):289-295, 1999)

Pneumoperitoneum in the cancer patient: advantages and pitfalls

The use of pneumoperitoneum to create a working environment for laparoscopic surgery may have both beneficial and detrimental effects in cancer patients. Studies suggest that immune mechanisms are protected when laparoscopic procedures are used and this does not seem to be compromised by the use of gas in the abdomen. Potential pitfalls in the utilization of pneumoperitoneum include the effects of hypothermia, cardiovascular consequences, hypercoagulability with associated deep-venous thrombosis, and the possibility that trocar-site recurrences may be produced by using a pneumoperitoneum. No concrete evidence of either beneficial or detrimental effects from pneumoperitoneum in cancer patients currently exists. Studies utilizing animal models and humans should be supported in this extremely important area.