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Nicole D. Bouvy, MD; Maria C. Giuffrida, MD; Larissa N. L. Tseng, MD; Ewout W. Steyerberg, PhD; Richard L. Marquet, PhD; Hans Jeekel, MD, PhD; H. Jaap Bonjer, MD, PhD

Arch Surg. 1998;133:652-656.

Background  The oncologic consequences of intraperitoneal carbon dioxide (CO₂) insufflation during the laparoscopic resection of cancer are under debate. The effect of other insufflating gases or gasless laparoscopy on cancer requires study.

Objective  To study body weight and tumor growth in rats after CO₂ pneumoperitoneum, air pneumoperitoneum, and gasless laparoscopy.

Methods  On day 1, an 8-mg bolus of ROS-1 tumor was placed under the renal capsule of both kidneys in rats. In experiment A, rats had either CO₂ insufflation (n=10) or a gasless laparoscopic bowel resection (n=10) on day 3 and were humanely killed after 7 days. In experiment B, rats had either a laparoscopic bowel resection with CO₂ insufflation (n=11) or insufflation with air (n=11) on day 3 and were killed after 7 days. In both experiments, postoperative weight loss and tumor growth were measured, and the differences were tested with an analysis of covariance.

Results  Renal subcapsular tumor growth in the group having gasless laparoscopy was less than that in the group having CO₂ pneumoperitoneum (P=.04). Postoperative weight loss in these groups showed no differences (P=.55). No differences in tumor growth or weight loss were found between rats having insufflation with CO₂ and those having insufflation with air (P=.61 and P =.68, respectively).

Conclusions  The restoration of body weight after a laparoscopic surgical procedure was similar with CO₂, air, or gasless laparoscopy. Gasless laparoscopy was associated with less renal subcapsular tumor growth than was insufflation with CO₂. Therefore, the application of gasless techniques in laparoscopic oncologic surgical treatment demands further study.

From the Department of Surgery, University Hospital Rotterdam, Dijkzigt (Drs Bouvy, Giuffrida, Tseng, Marquet, Jeekel, and Bonjer), and the Department of Public Health, Erasmus University (Dr Steyerberg), Rotterdam, the Netherlands.

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