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Reduction of the inflammatory response using wet CO2 during laparoscopy
Abstracts
Doppler ultrasound. Five women in whom preoperative CA 125 levels were available had values within the normal range. Conclusion. Although preoperative clinical findings were not alarming in this group of women, frozen section examination at the time of laparoscopy picked up almost all of the malignancies.
viscosity and surface tension during dynamic compression and after timed exposure to intermittent or continuous dry or wet CO2 flow. Peritoneal fluid pH decreased but was statistically the same for both dry and wet gas exposures. During continuous dry gas flow, water concentration decreased dramatically and solute concentration increased. Complete evaporation of the bubble of peritoneal fluid occurred in 45 seconds at a flow rate of 100 ml/minute. Viscosity measured in centipoise increased from 1.43 to 78. Intermittent gas flow showed a similar pattern to evaporation but was shifted to the right. Surface tension decreased as water concentration decreased. With wet gas, water concentration and viscosity were maintaJned as normal with no loss of surface tension quality. Conclusion. Exposure of the peritoneal cavity and peritoneal tissue during laparoscopy to dry CO2, whether continuous or intermittent, decreases water content, increases viscosity, and deteriorates the surface tension qualities of peritoneal fluid. Wet gas exposure (95%) during laparoscopy, continuous or intermittent, maintains normal water content, viscosity, and surface tension characteristics of peritoneal fluid.
136. Reduction of the Inflammatory Response Using Wet CO2 During Laparoscopy DE Ott. Mercer University, School of Engineering and School of Business, Macon, Georgia.
Objective. To evaluate the acute phase and cytokine response of serum IL-6 and C-reactive protein (CRP) during laparoscopy comparing cold, dry CO2 with warmed, humidified CO2. Measurements and Main Results. Twenty-seven patients were randomized to have insufflation with cold, dry CO2 and 25 with warm, wet CO2 at laparoscopy performed for benign reasons. Preoperative IL-6 and CRP values were not different between groups (Maxm-Whitney U test). Comparison of wet CO2 and dry CO2 showed IL-6 6 + 3 versus 24 + 9 pg/ml x hour x 10 (p <0.002) and CRP 5 + 2 versus 23 + 6 mg/dl x hour x 10 (p <0.003). Conclusion. Changes in IL-6 and CRP are directly related to dry gas volume used. The decreased inflammatory response to warm, wet gas is an indication of reduced peritoneal trauma. Peritoneal trauma is due to desiccation caused by cold, dry gas. Warming and wetting CO2 eliminates inflammation caused by tissue drying and desiccation.
138. Recognizing the Hazards of Mechanical Morcellation with Use of Retrieval Bags AC Pagedas. St. Francis Hospital, Greendale, Wisconsin.
Objective. To describe substantial shortcomings of morcellation using current retrieval bags. Measurements and Main Results. Of all endoscopic instrument injuries, those caused by morcellators can be the most devastating, even more than those from electrical current. This is not necessarily the fault of the surgeon. The design of morcellators and lap sacs is outdated and must be made safer. Just as automobile safety is improved by speed limits, safety belts, and air bags, morcellators should have variable speeds allowing the surgeon to confirm placement of the instruments. A spring-loaded, retractable, clear, plastic safety shield safeguards the rotating blade. There should be an option of different blades for various tissue consistencies. Lap sacs can be developed to be of a certain shape for better specimen alignment to the morcellator blade. The lap sac material can have within its wall fine metal fragments, such that should the morcellator come in contact with these conductive
137. Water Content of Laparoscopic Gas Affects Peritoneal Fluid Function DE Ott. Mercer University, School of Engineering and School of Business, Macon, Georgia.
Objective. To evaluate peritoneal fluid surface tension characteristics as a result of exposure to dry or wet CO2. Measurements and Main Results. Peritoneal fluid samples were obtained from 20 patients having tubal ligation with no known peritoneal pathology. Samples were exposed to continuous or intermittent flow of bone-dry CO2 or CO2 humidified to 95% using the Insuflow device. Samples were evaluated by bubble suffactometric and viscometric analyses to evaluate
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Doppler ultrasound. Five women in whom preoperative CA 125 levels were available had values within the normal range. Conclusion. Although preoperative clinical findings were not alarming in this group of women, frozen section examination at the time of laparoscopy picked up almost all of the malignancies.
viscosity and surface tension during dynamic compression and after timed exposure to intermittent or continuous dry or wet CO2 flow. Peritoneal fluid pH decreased but was statistically the same for both dry and wet gas exposures. During continuous dry gas flow, water concentration decreased dramatically and solute concentration increased. Complete evaporation of the bubble of peritoneal fluid occurred in 45 seconds at a flow rate of 100 ml/minute. Viscosity measured in centipoise increased from 1.43 to 78. Intermittent gas flow showed a similar pattern to evaporation but was shifted to the right. Surface tension decreased as water concentration decreased. With wet gas, water concentration and viscosity were maintaJned as normal with no loss of surface tension quality. Conclusion. Exposure of the peritoneal cavity and peritoneal tissue during laparoscopy to dry CO2, whether continuous or intermittent, decreases water content, increases viscosity, and deteriorates the surface tension qualities of peritoneal fluid. Wet gas exposure (95%) during laparoscopy, continuous or intermittent, maintains normal water content, viscosity, and surface tension characteristics of peritoneal fluid.
136. Reduction of the Inflammatory Response Using Wet CO2 During Laparoscopy DE Ott. Mercer University, School of Engineering and School of Business, Macon, Georgia.
Objective. To evaluate the acute phase and cytokine response of serum IL-6 and C-reactive protein (CRP) during laparoscopy comparing cold, dry CO2 with warmed, humidified CO2. Measurements and Main Results. Twenty-seven patients were randomized to have insufflation with cold, dry CO2 and 25 with warm, wet CO2 at laparoscopy performed for benign reasons. Preoperative IL-6 and CRP values were not different between groups (Maxm-Whitney U test). Comparison of wet CO2 and dry CO2 showed IL-6 6 + 3 versus 24 + 9 pg/ml x hour x 10 (p <0.002) and CRP 5 + 2 versus 23 + 6 mg/dl x hour x 10 (p <0.003). Conclusion. Changes in IL-6 and CRP are directly related to dry gas volume used. The decreased inflammatory response to warm, wet gas is an indication of reduced peritoneal trauma. Peritoneal trauma is due to desiccation caused by cold, dry gas. Warming and wetting CO2 eliminates inflammation caused by tissue drying and desiccation.
138. Recognizing the Hazards of Mechanical Morcellation with Use of Retrieval Bags AC Pagedas. St. Francis Hospital, Greendale, Wisconsin.
Objective. To describe substantial shortcomings of morcellation using current retrieval bags. Measurements and Main Results. Of all endoscopic instrument injuries, those caused by morcellators can be the most devastating, even more than those from electrical current. This is not necessarily the fault of the surgeon. The design of morcellators and lap sacs is outdated and must be made safer. Just as automobile safety is improved by speed limits, safety belts, and air bags, morcellators should have variable speeds allowing the surgeon to confirm placement of the instruments. A spring-loaded, retractable, clear, plastic safety shield safeguards the rotating blade. There should be an option of different blades for various tissue consistencies. Lap sacs can be developed to be of a certain shape for better specimen alignment to the morcellator blade. The lap sac material can have within its wall fine metal fragments, such that should the morcellator come in contact with these conductive
137. Water Content of Laparoscopic Gas Affects Peritoneal Fluid Function DE Ott. Mercer University, School of Engineering and School of Business, Macon, Georgia.
Objective. To evaluate peritoneal fluid surface tension characteristics as a result of exposure to dry or wet CO2. Measurements and Main Results. Peritoneal fluid samples were obtained from 20 patients having tubal ligation with no known peritoneal pathology. Samples were exposed to continuous or intermittent flow of bone-dry CO2 or CO2 humidified to 95% using the Insuflow device. Samples were evaluated by bubble suffactometric and viscometric analyses to evaluate
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