Introduction: We have published that the use of humidified-warm carbon dioxide (H-WCO2) for laparoscopic-insufflation protects mice from peritoneal damage, inflammation and carcinomatosis (1).
Aims: In this study we have explored the effects of delivering H-WCO2 into the open abdomen of mice in order to simulate laparotomy in patients.
Methods: Mice were anesthetized, intubated and subjected to a longitudinal incision of the abdomen along with retractors to expose organs and the peritoneal wall. In the test cohort a diffuser device was connected to allow delivery of H-WCO2. Additionally in each group of mice “surgical” damage was generated on one side to the peritoneal wall. Vital signs and core temperature were monitored throughout over one hour. The incision was closed and mice were allowed to recover for 24 hours or 10 days. Peritoneal tissue was examined by SEM and IHC as well as for support of tumorigenesis.
Results: Exposure to passive air flow for only one hour was associated with ultrastructural damage including mesothelial cell bulging and loss of microvilli when assessed at 24 hrs. Evidence of “surgical” damage was still measureable at day 10. Hypoxia-inducible-factor-1 alpha and vascular-endothelial-growth-factor-A were also detected in the peritoneum. H-WCO2 allowed maintenance of normothermia. In addition, the degree of tissue damage was significantly reduced by H-WCO2. HIF1a and VEGFA expression was similarly lower and this was also evident at the surgical damage sites whereby protection extended out to the 10 days. Tumours formed at the surgical damage sites in all animals.
Conclusions: Employing H-WCO2 perfusion into the abdomen in the context of open surgery affords tissue protection in mice and faster tissue repair.
(1). Carpinteri, S., Sampurno, S., Bernardi, M., Germann, M., Malaterre, J., Heriot, A., Chambers, B.A., Mutsaers, S.E., Lynch, A.C. and Ramsay, R.G. (2015). Peritoneal Tumorigenesis and Inflammation are ameliorated by Humidified-Warm Carbon Dioxide Insufflation in the Mouse. Annals of Surgical Oncology Suppl 3:S1540-7.