caa a22 4500 475780604 CHVBK 20180406123643.0 cr unu---uuuuu 170329e20000401xx s 000 0 eng 10.1007/s004640000156 doi (NATIONALLICENCE)springer-10.1007/s004640000156 Effect of pressure and gas type on intraabdominal, subcutaneous, and blood pH in laparoscopy [Elektronische Daten] [C. Kuntz, A. Wunsch, C. Bödeker, F. Bay, R. Rosch, J. Windeler, C. Herfarth] Background: According to the literature, the number of port-site metastases in laparoscopic surgery varies considerably depending on the type of gas used for the pneumoperitoneum. In order to investigate this observation we studied the changes in blood, subcutaneous, and intra-abdominal pH during laparoscopy with helium, CO2 and room air in a rat model. In addition, we looked at the influence of intra-abdominal pressure and duration of pneumoperitoneum on the pH during the laparoscopy. Methods: pH was measured by tonometry, intra-abdominally and subcutaneously. A pH electrode was additionally placed into the subcutaneous tissue and the results compared to those measured by tonometry. Blood samples were taken from a catheter in the carotid artery. The intra-abdominal pressure was 0, 3, 6, 9 mmHg for 30 min in each case. We investigated the effect of pneumoperitoneum with CO2, helium and air in randomized groups of 5 rats. In an additional series the pressure was held constant at 3 mmHg and the pH was measured every 30 min. Results: Due to the different absorption capacity of the peritoneum, laparoscopy with CO2 decreases the subcutaneous pH from 7.35 to 6.81. Blood pH is reduced from 7.37 to 7.17 and the intra-abdominal pH from 7.35 to 6.24. Other, less absorbable gases induce smaller changes of blood and subcutaneous pH (only 10% of CO2). In a variance analysis the p value is less than 0.001. The influence of duration of laparoscopy (30 min vs 90 min) on the subcutaneous pH is less compared to the influence of intra-abdominal pressure (0, 3, 6, 9 mmHg). Conclusions: Depending on the type of gas (CO2, air, helium) used for laparoscopy blood, subcutaneous and intra-abdominal pH are influenced differently. Because lower pH is known to impair local defense mechanisms, these results may be one explanation for the higher incidence of port-site metastasis in laparoscopy with CO2 than with other gases, as reported in the literature. Springer-Verlag New York Inc., 2000 Key words: Pneumoperitoneum — CO2— Helium — Blood pH — Intra-abdominal pH — Subcutaneous pH — Laparoscopy nationallicence Kuntz C. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany, DE aut Wunsch A. Department of Transplant Surgery, University of Mainz, Laugenbeckstrasse 1, D55101 Mainz, Germany, DE aut Bödeker C. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany, DE aut Bay F. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany, DE aut Rosch R. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany, DE aut Windeler J. Institute of Medical Biometry, University of Heidelberg, Im Neuenheimer Feld 305, D 69120 Heidelberg, Germany, DE aut Herfarth C. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany, DE aut Surgical Endoscopy Springer-Verlag 14/4(2000-04-01), 367-371 0930-2794 14:4<367 2000 14 464 https://doi.org/10.1007/s004640000156 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004640000156 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kuntz C. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany, DE aut NATIONALLICENCE 700 1- Wunsch A. Department of Transplant Surgery, University of Mainz, Laugenbeckstrasse 1, D55101 Mainz, Germany, DE aut NATIONALLICENCE 700 1- Bödeker C. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany, DE aut NATIONALLICENCE 700 1- Bay F. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany, DE aut NATIONALLICENCE 700 1- Rosch R. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany, DE aut NATIONALLICENCE 700 1- Windeler J. Institute of Medical Biometry, University of Heidelberg, Im Neuenheimer Feld 305, D 69120 Heidelberg, Germany, DE aut NATIONALLICENCE 700 1- Herfarth C. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany, DE aut NATIONALLICENCE 773 0- Surgical Endoscopy Springer-Verlag 14/4(2000-04-01), 367-371 0930-2794 14:4<367 2000 14 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer