Humidity: The Critical Difference
Heated insufflation tubes and heated insufflators for CO2 gas delivery utilized during laparoscopy have been proven to offer no benefit to the patient.
The truth is all the scientific data regarding post-operative benefits and maintenance of core body temperature is based on delivery of both 95% humidified and 95oF warmed CO2 with the use of the Insuflow® Laparoscopic Gas Conditioning Device
Humidity preserves the natural water content of the peritoneal fluid covering peritoneal tissue, prevents cell desiccation and reduces hypothermia. In addition, humid CO2 gas treatment has consistently proven to reduce the amount of analgesic medication and the side effects they cause.
Don’t be fooled by heated CO2 gas!
The use of heated insufflation tubes and heated insufflators have been proven to offer no benefit to the patient and is an unnecessary added expense to laparoscopic surgical procedures. These products may actually do more harm to the patient since warm dry CO2 gas dries the peritoneum during laparoscopy causing faster evaporation of water from peritoneal fluid and peritoneal tissue, increased peritoneal cell desiccation and cell death and increased peri-operative hypothermia. In addition, heated only CO2 has been attributed to increased post-operative pain.
Heated only CO2 gas does not reduce post-operative pain for laparoscopic patients!
A Randomized Controlled Trial Assessing the Effect of Heated Carbon Dioxide for Insufflation on Pain and Recovery After Laparoscopic Fundoplication
Wills V, Hunt D, Armstrong A. Surg Endosc, 2001, 15:166-170
“Conclusion: Heated gas provides no benefit for patients and may be associated with increased early pain. The elevation of core body temperature observed with heated CO2 is of little clinical significance.”
Effect of CO2 Gas Warming on Pain after Laparoscopic Surgery: A Randomized Double-blind Controlled Trial
Slim K, Bousquet J, Swiatkowski F, Lescure G, Pezet D, Chipponi J. Surg Endosc. 1999, 13:1110-4
“Conclusion: Gas warming does not reduce, and probably increases, postoperative shoulder tip and subcostal pain.”
Humidifed Compared With Dry, Heated Carbon Dioxide at Laparoscopy to Reduce Pain
Beste T, Daucher J, Holbert D. Obstetrics & Gynecology, 2006, Vol. 107, No.2, Part 1
“Conclusion: At laparoscopy, heated, 95% humidified CO2 effectively decreases postoperative pain and narcotics usage compared with heated, dry CO2.”
Heated only CO2 does not reduce hypothermia for laparoscopic patients!
Carbon Dioxide Gas Heating Inside Laparoscopic Insufflators Has No Effect
Jacobs V, Kiechle M, Morrison J. JSLS 2005; 9:208-212
“Discussion: Insufflator internal gas heating” “can not have a clinically significant effect because it is too far away from the patient to raise the gas temperature in the abdomen. Purchasers are misled because the gas-heating device has no measurable benefit for the patient.”
Influence of Gas Temperature During Laparoscopic Procedures
Bessell J, Maddern G. The Pathophysiology of Pneumoperitoneum, Springer, 1998. Rosenthal R, Friedman R, Phillips E, editors. Chapter 3, 18-27
Effect of Cold and Warm Insufflated CO2:
“warmed rather than cold insufflated gas confers no protection against changes in core temperature during laparoscopic surgery.” “The answer is provided by the principles of thermodynamics; considerably more heat expenditure from the patients is required to humidify the initially dry CO2 stream, than is used to raise the ambient temperature of the CO2 gas to a physiological temperature.”
Effect of Humidifying Insufflated CO2: “Prevention of water loss” by evaporation “is the most important factor for the prevention of laparoscopic hypothermia.”
Conclusions: “It is important for the clinician utilizing non-humidified insufflation equipment to be aware of” “commercial pressure to purchase gas-warming insufflators when in fact their touted benefits have no physiological validity.” “The use of warmed but also humidified gas to maintain temperature homeostasis during laparoscopy must be advocated.”
Intraoperative Evaluation of Laparoscopic Insufflation Technique for Quality Control in the OR
Jacobs V, Morrison J, Mundhenke C, Golombeck K, Jonat W. JSLS 2000; 4:189-195
Discussion: “Internal heating of gas in the insufflator is inefficient because CO2 gas at the end of the insufflation hose is at room temperature. Maintaining body temperature with standard warming equipment” “is possible,” “but take care of the problem (hypothermia) after it occurs.” “Recent studies seem to have solved the problem with Insuflow®, a patient close-gas heating and hydration device.”
Severe Local Hypothermia from Laparoscopic Gas Evaporative Jet Cooling: A Mechanism To Explain Clinical Observations
Gray R, Ott D, Henderson A, Cochran S, Roth E. JSLS 1999; 3:171-177
“Conclusions: Evaporative cooling accounts for significant hypothermia. The cooling is dependent on the lack of water vapor in the gases currently used during laparoscopy.” “Heating and hydrating the gas to a physiologic condition eliminates hypothermia and tissue desiccation.”
Heated Only CO2 Gas does not prevent peritoneal drying and desiccation!
Peritoneal Cell Death Due to Heated-Only CO2 Insufflation
Johnston G, Ott D. J Am Assoc Gynecol Laparosc 9(3):527, 2002
Conclusion: “Rapid evaporation caused by dry gas and gas flow desiccates the cell. It is necessary to warm wet gas to preserve normal tissue moisture, maintain cellular integrity, and prevent cell death. Warmed-only CO2 (warm and still bone-dry) results in loss of peritoneal cell integrity and causes cell death.”
Peritoneal Drying and Desiccation is Caused by Heated Only Carbon Dioxide.
Ott D, Johnston Jr. G. ASRM 2002
“Conclusions: Cold dry and warmed only carbon dioxide gas exposure caused cell stress leading to cellular death and loss of viability and is due to desiccation effect. Both warming and wetting the gas is necessary to preserve the normal cellular integrity and prevent cell death.”
Maintenance of Cell Viability at Laparoscopy by Hydration of CO2
Garner R, Wright E, Ott D. J Am Assoc Gynecol Laparosc 7(35):519, 2000.
Measurements and Main Results: “Viability of cells exposed to unconditioned CO2 showed significant percentage of death attributable to desiccation at 4- to 5-minute exposure. Cells exposed to CO2 containing 75% or 95% humidity showed sustained viability even after 20 minutes exposure.”
“Conclusion: These data demonstrate the importance of modifying CO2 by heating and hydration to reduce cellular stress, reduce desiccation, and prevent cell death.”
Laparoscopy and Tribology: The Effect of Laparoscopic Gas on Peritoneal Fluid
Ott D. J Am Assoc Gynecol Laparosc 8(1):117-123, 2001
“Conclusion: Very dry CO2 for laparoscopy causes peritoneal fluid viscosity to increase dramatically.”
The Insuflow® Laparoscopic Gas Conditioning Device is the only product that delivers both hydrated (95% relative humidity) and warmed (95oF) CO2 for laparoscopy and is proven in over 45 clinical studies to improve laparoscopic patient care.
Improvement of Clinical Outcomes for Laparoscopic Gastric Banding Patients by Using the Insuflow® Pre-Conditioning Gas Device for the Pneumoperitoneum
Benavides R, Powell R, Wong A, Nguyen H, as given at ASBS, 2006 in publication.
“Conclusions: Changing the quality of gas insufflation gas to a normal homeostatic physiologic environment using the Insuflow® reduces shoulder pain, shortness recovery room length of stay and decreases pain medication requirements up to ten days post-operatively in laparoscopic gastric banding patients. Dry heated gas may cause additional complications due to the increase in pain medication and pain intensity.”
Complete studies for educational purposes are available upon request by contacting LEXION Medical toll free at 877-9-LEXION or customerservice@lexionmedical.com.
