Gasless laparoscopy may reduce the risk of port-site metastases following laparascopic tumor surgery

D. I. Watson, G. Mathew, T. Ellis, C. F. Baigrie, A. M. Rofe and G. G. Jamieson
Royal Adelaide Centre for Endoscopic Surgery, Royal Adelaide Hospital, South Australia.

OBJECTIVE: To compare the incidence of port-site metastases in an experimental tumor model following tumor manipulation during laparoscopy aided by conventional insufflation with laparoscopy using a gasless technique. SETTING: An experimental model applied in a research laboratory. PARTICIPANTS AND INTERVENTIONS: Malignant tumors were implanted in the abdominal wall of 24 rats. Twelve rats underwent tumor laceration at laparoscopy with carbon dioxide insufflation, and 12 rats underwent the same procedure during gasless laparoscopy achieved by abdominal wall suspension. Rats were killed 1 week later and were examined for evidence of tumor metastases. The surgical wounds were examined microscopically by a histopathologist who was unaware of the operative technique used and the site of origin of the specimens. MAIN OUTCOME MEASURE: Histologically confirmed tumor metastasis to laparoscopic port wounds. RESULTS: Growth of the primary tumor was equal in both groups. Wound metastases were less likely in the gasless laparoscopy group (3 of 12 vs 10 of 12; P = .01, Fisher exact test). CONCLUSION: The use of laparoscopy without gas insufflation may reduce the risk of wound metastasis following laparoscopic surgery for cancer.