caa a22 4500 475781945 CHVBK 20180406123647.0 cr unu---uuuuu 170329e20001101xx s 000 0 eng 10.1007/s004640000216 doi (NATIONALLICENCE)springer-10.1007/s004640000216 Laparoscopyrid="" [Elektronische Daten] Searching for the proper insufflation gasid=""Presented at the meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), San Antonio, Texas, USA, March 1999 [T. Menes, H. Spivak] Background: Although many aspects of laparoscopic surgery have been determined, the question of which insufflation gas is the best arises repeatedly. The aim of this study was to review the findings on the major gases used today in order to provide information and guidelines for the laparoscopic surgeon. Methods: We reviewed the literature for clinical and laboratory studies on the currently used laparoscopic insufflation gases: carbon dioxide (CO2), nitrous oxide (N2O), helium (He), air, nitrogen (N2), and argon (Ar). The following parameters were evaluated: acid-base changes, hemodynamic and respiratory sequelae, hepatic and renal blood flow changes, increase in intracranial pressure, outcome of venous emboli, and port-site tumor growth. Results: The major advantage of CO2 is its rapid dissolution in the event of venous emboli. Hemodynamic and acid-base changes with CO2 insufflation usually are mild and clinically negligible for most patients. Although N2O is advantageous for procedures requiring local/regional anesthesia, it does not suppress combustion. Findings show that Ar may have unwanted hemodynamic effects, especially on hepatic blood flow. There are almost no hemodynamic or acid-base sequelae with the use of He, air, and N2, but they dissolve slowly and carry a potential risk of lethal venous emboli. Conclusions: Clearly, CO2 maintains its role as the primary insufflation gas in laparoscopy, but N2O has a role in some cases of depressed pulmonary function or in local/regional anesthesia cases. Other gases have no significant advantage over CO2 or N2O and should be used only in protocol studies. The relation of port-site metastasis to a specific type of gas requires further research. Springer-Verlag New York Inc., 2000 Key words: Insufflation gas — Intracranial pressure — Laparoscopy — Port-site metastases — Venous emboli nationallicence Menes T. Unit of Advanced Laparoscopic Surgery, Rabin Medical Center, Petah Tikva, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, IL aut Spivak H. Unit of Advanced Laparoscopic Surgery, Rabin Medical Center, Petah Tikva, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, IL aut https://doi.org/10.1007/s004640000216 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004640000216 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Menes T. Unit of Advanced Laparoscopic Surgery, Rabin Medical Center, Petah Tikva, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, IL aut NATIONALLICENCE 700 1- Spivak H. Unit of Advanced Laparoscopic Surgery, Rabin Medical Center, Petah Tikva, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, IL aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer