Surgical humidification

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Surgical humidification is the conditioning of insufflation gas with water vapour (humidity) and heat during surgery. Surgical humidification is used to reduce the risk of tissue drying and evaporative cooling.

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Laparoscopic surgery humidification

During laparoscopy (laparoscopic surgery or minimally invasive surgery), it is necessary to insufflate the abdominal cavity (i.e. inflate the abdomen like a balloon) with medical-grade carbon dioxide (CO2) to create a viewing and working space for the surgery. The CO2 may be unconditioned, or conditioned with heat, or with humidification and heat. During insufflation, the peritoneum (an extensive delicate membrane that lines the abdominal cavity and covers most of the abdominal organs) is exposed to the CO2.[ citation needed ]

Unconditioned medical-grade CO2 has virtually no moisture [1] and enters the abdomen at room temperature (19 to 21 °C). [2] The condition of the gas is dry and cold compared to that of the natural physiological state of the peritoneum which is immersed in fluid at body temperature (37 °C). Experimental and clinical investigations have demonstrated that insufflation with unconditioned CO2 causes evaporation of the fluid and drying of the peritoneum, resulting in inflammation and damage to its cells. [3] [4] [5] Clinically, peritoneal injury caused by drying has been linked to post-operative pain, [6] [7] [8] evaporative cooling resulting in a decrease in core temperature and increased risk of intra-operative hypothermia, [7] [9] [10] [11] [12] as well as adhesion formation. [4] [13]

In addition, animal studies have revealed that surgical humidification reduces peritoneal tumor implantation and tumor load [14] [15] suggesting a possible benefit in cancer patients undergoing abdominal surgery.

Conditioning the CO2 with only heat causes tissue drying. [16] Warmer gas has a greater capacity for evaporation as the gas can hold more water vapor, therefore the tissues will dry faster than when unconditioned gas is used, potentially leading to increased adverse consequences. [17] [18] [19] Conditioning the CO2 with humidity, in combination with heat, has been shown to decrease peritoneal damage by reducing the capacity of CO2 to carry moisture away from the tissue. [3] [4] Temperature loss during surgery, due to tissue drying, can be prevented by adequately humidifying and heating the CO2. [4] [6] [7] [10] [13] [20]

Open (abdominal) surgery humidification

During open surgery the surgeon exposes the peritoneal cavity to the ambient air. Exposure to ambient air results in evaporation and cooling. Current studies have shown that the use of surgical humidification during open abdominal surgery (laparotomy) have warmer core body temperatures and reduced risk of operative hypothermia. [21] [22] As with any operation, maintaining patient normothermia is a critical process to prevent surgical site infections, additional respiratory distress and surgical bleeding. [23] [24]

Respiratory humidification during surgery

Anesthesia causes vasodilatation, which increases blood flow to the surface of the body and thus increases heat loss from the body. During anesthesia, blood flow to the surface may maintain skin temperature (which is normally lower than the core temperature), even while the core temperature is falling. [25] Barring preventive interventions, hypothermia occurs in more than half of all surgical patients undergoing anesthesia. [26]

The risk of a loss of body temperature and hypothermia increase with the duration of surgery, especially for surgery that lasts more than one hour. Surgical hypothermia, defined as a core temperature below 36.0 °C, is associated with increased risk of infectious and non-infections complications, [27] longer post-operative ICU and overall hospital recovery, and more frequent requirement of transfusions. [28] [29] Elderly persons, especially those with lower muscle and body mass are at greater risk of hypothermia. [30]

Respiratory humidification during surgery helps maintain body temperature and normal function of the respiratory mucosa. [31] [32] In the same way that some animals pant to lose excess body heat, heat is lost through the lungs during mechanical or assisted ventilation. Heated humidification of respiratory gases during surgery has been demonstrated to reduce the fall in core body temperature, especially in surgeries lasting longer than one hour. The lungs can be insufflated with respiratory gases that are heated to near body temperature and humidified to 90 to 100% relative humidity(RH). Normally, air in the lungs is at core body temperature and at close to 100% RH. Especially when cold dry gases (such as anhydrous compressed gas from oxygen tanks) are used, it cool and can dry the airway. The body then utilizes energy to evaporate sufficient water from the lungs to maintain lung gas temperature and humidity. It is generally estimated that 10 percent of the loss of body heat during surgery is from the respiratory tract. [33] Especially in open surgery (rather than endoscopic/robotic surgery), respiratory humidification can be used in concert with forced air warming blankets or gowns, warmed IV, and irrigation fluids to prevent hypothermia.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Laparoscopy</span> Minimally invasive operation within the abdominal or pelvic cavities

Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.

<span class="mw-page-title-main">Peritonitis</span> Inflammation of the inner wall of the abdomen (peritoneum)

Peritonitis is inflammation of the localized or generalized peritoneum, the lining of the inner wall of the abdomen and cover of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. One part or the entire abdomen may be tender. Complications may include shock and acute respiratory distress syndrome.

<span class="mw-page-title-main">Hiatal hernia</span> Entrance of abdominal organs into the middle chest through the diaphragm

A hiatal hernia or hiatus hernia is a type of hernia in which abdominal organs slip through the diaphragm into the middle compartment of the chest. This may result in gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) with symptoms such as a taste of acid in the back of the mouth or heartburn. Other symptoms may include trouble swallowing and chest pains. Complications may include iron deficiency anemia, volvulus, or bowel obstruction.

A laparotomy is a surgical procedure involving a surgical incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy.

<span class="mw-page-title-main">Cholecystectomy</span> Surgical removal of the gallbladder

Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. In 2011, cholecystectomy was the eighth most common operating room procedure performed in hospitals in the United States. Cholecystectomy can be performed either laparoscopically, or via an open surgical technique.

<span class="mw-page-title-main">Mesentery</span> Contiguous fold of tissues that supports the intestines

In human anatomy, the mesentery, an organ that attaches the intestines to the posterior abdominal wall, comprises the double fold of the peritoneum. It helps in storing fat and allowing blood vessels, lymphatics, and nerves to supply the intestines.

<span class="mw-page-title-main">Nissen fundoplication</span> Surgical procedure to treat gastric reflux and hiatal hernia

A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. In GERD, it is usually performed when medical therapy has failed; but, with a Type II (paraesophageal) hiatus hernia, it is the first-line procedure. The Nissen fundoplication is total (360°), but partial fundoplications known as Thal, Belsey, Dor, Lind, and Toupet fundoplications are alternative procedures with somewhat different indications and outcomes.

<span class="mw-page-title-main">Minimally invasive procedure</span> Surgical technique that limits size of surgical incisions needed

Minimally invasive procedures encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definition is invasive, and many operations requiring incisions of some size are referred to as open surgery. Incisions made during open surgery can sometimes leave large wounds that may be painful and take a long time to heal. Advancements in medical technologies have enabled the development and regular use of minimally invasive procedures. For example, endovascular aneurysm repair, a minimally invasive surgery, has become the most common method of repairing abdominal aortic aneurysms in the US as of 2003. The procedure involves much smaller incisions than the corresponding open surgery procedure of open aortic surgery.

<span class="mw-page-title-main">Hernia repair</span> Surgical procedures to fix abnormal openings through which tissue or organs may protrude

Hernia repair is a surgical operation for the correction of a hernia—a bulging of internal organs or tissues through the wall that contains it. It can be of two different types: herniorrhaphy; or hernioplasty. This operation may be performed to correct hernias of the abdomen, groin, diaphragm, brain, or at the site of a previous operation. Hernia repair is often performed as an ambulatory procedure.

<span class="mw-page-title-main">Pneumoperitoneum</span> Abnormal presence of gases in the peritoneal cavity of the abdomen

Pneumoperitoneum is pneumatosis in the peritoneal cavity, a potential space within the abdominal cavity. The most common cause is a perforated abdominal organ, generally from a perforated peptic ulcer, although any part of the bowel may perforate from a benign ulcer, tumor or abdominal trauma. A perforated appendix seldom causes a pneumoperitoneum.

An incisional hernia is a type of hernia caused by an incompletely-healed surgical wound. Since median incisions in the abdomen are frequent for abdominal exploratory surgery, ventral incisional hernias are often also classified as ventral hernias due to their location. Not all ventral hernias are from incisions, as some may be caused by other trauma or congenital problems.

<span class="mw-page-title-main">Trocar</span> Medical or veterinary device

A trocar is a medical or veterinary device used in minimally invasive surgery. Trocars are typically made up of an awl, a cannula and often a seal. Some trocars also include a valve mechanism to allow for insufflation. Trocars are designed for placement through the chest and abdominal walls during thoracoscopic and laparoscopic surgery, and each trocar functions as a portal for the subsequent insertion of other endoscopic instruments such as grasper, scissors, stapler, electrocautery, suction tip, etc. — hence the more commonly used colloquial jargon "port". Trocars also allow passive evacuation of excess gas or fluid from organs within the body.

<span class="mw-page-title-main">Adhesion (medicine)</span> Fibrous bands that form between tissues and organs, usually due to injury

Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue that connects tissues not normally connected.

<span class="mw-page-title-main">Phrenicocolic ligament</span>

A fold of peritoneum, the phrenicocolic ligament is continued from the left colic flexure to the thoracic diaphragm opposite the tenth and eleventh ribs; it passes below and serves to support the spleen, and therefore has received the name of sustentaculum lienis.

<span class="mw-page-title-main">Obturator hernia</span> Medical condition

An obturator hernia is a rare type of hernia, encompassing 0.07-1% of all hernias, of the pelvic floor in which pelvic or abdominal contents protrudes through the obturator foramen. The obturator foramen is formed by a branch of the ischial as well as the pubic bone. The canal is typically 2-3 centimeters long and 1 centimeters wide, creating a space for pouches of pre-peritoneal fat.

Single-port laparoscopy (SPL) is a recently developed technique in laparoscopic surgery. It is a minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient's navel. Unlike a traditional multi-port laparoscopic approach, SPL leaves only a single small scar.

Insufflation is the act of blowing something into a body cavity. Insufflation has many medical uses, most notably as a route of administration for various drugs.

Single-incision laparoscopic surgery (SILS) is an advanced, minimally invasive (keyhole) procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient's umbilicus (navel). Special articulating instruments and access ports eliminate the need to place trochars externally for triangulation, thus allowing the creation of a small, solitary portal of entry into the abdomen.

<span class="mw-page-title-main">Hyperthermic intraperitoneal chemotherapy</span>

Intraperitoneal hyperthermic chemoperfusion is a type of hyperthermia therapy used in combination with surgery in the treatment of advanced abdominal cancers. In this procedure, warmed anti-cancer medications are infused and circulated in the peritoneal cavity (abdomen) for a short period of time. The chemotherapeutic agents generally infused during IPHC are mitomycin-C and cisplatin.

A Veress needle or Veres needle is a spring-loaded needle used to create pneumoperitoneum for laparoscopic surgery. Of the three general approaches to laparoscopic access, the Veress needle technique is the oldest and most traditional.

References

  1. ↑ United States Pharmacopoeia and the National Formulary Supplements. 26-NF 21. 3rd ed (United States Pharmacopeial Convention: 2003, NJ). 2003.{{cite journal}}: Missing or empty |title= (help)
  2. ↑ Puttick, M; Scott-Coombes D; Dye J; Nduka C; Menzies-Gow N; Mansfield A; Darzi A (1999). "Comparison of immunologic and physiologic effects of CO2 pneumoperitoneum at room and body temperatures". Surg Endosc. 13 (6): 572–575. doi:10.1007/s004649901043. PMID   10347293. S2CID   21301841.
  3. 1 2 Erikoglu, M; Yol S; Avunduk MC; Erdemli E; Can A (2005). "Electron-microscopic alterations of the peritoneum after both cold and heated carbon dioxide pneumoperitoneum". J Surg Res. 125 (1): 73–77. doi:10.1016/j.jss.2004.11.029. PMID   15836853.
  4. 1 2 3 4 Peng, Y; Zheng M; Ye Q; Chen X; Yu B; Liu B (2009). "Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations". J Surg Res. 151 (1): 40–47. doi:10.1016/j.jss.2008.03.039. PMID   18639246.
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  13. 1 2 Binda, M; Molinas C; Hansen P; Koninckx P (2006). "Effect of desiccation and temperature during laparoscopy on Adhesion formation in mice". Fertil Steril. 86 (166–175): 166–75. doi:10.1016/j.fertnstert.2005.11.079. PMID   16730008.
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  23. ↑ Baucom, Rebeccah B.; Phillips, Sharon E.; Ehrenfeld, Jesse M.; Muldoon, Roberta L.; Poulose, Benjamin K.; Herline, Alan J.; Wise, Paul E.; Geiger, Timothy M. (2015-06-01). "Association of Perioperative Hypothermia During Colectomy With Surgical Site Infection". JAMA Surgery. 150 (6): 570–575. doi: 10.1001/jamasurg.2015.77 . ISSN   2168-6262. PMID   25902410.
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  25. ↑ Hyungseok Seo; Kyungmi Kim; Eun-a Oh; Yeon-jin Moon; Young-Kug Kim; Jai-Hyun Hwang (2016). "Effect of electrically heated humidifier on intraoperative core body temperature decrease in elderly patients: a prospective observational study". Anesth Pain Med. 2013 (11): 211–216. doi: 10.17085/apm.2016.11.2.211 .
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