What are the characteristics of an ideal gas in Laparoscopic (Laparoscopic) surgery?

From the Guidelines

Carbon dioxide (CO2) is the ideal gas for use in laparoscopic surgery due to its high solubility in blood, non-combustible properties, and high diffusion coefficient. The use of CO2 for insufflation is encouraged in all endoscopic procedures, especially those with an increased risk of perforation, as stated in a 2021 expert review published in Clinical Gastroenterology and Hepatology 1. CO2 is highly soluble in blood, which allows for rapid absorption and elimination from the body, reducing the risk of gas embolism. Its non-combustible nature eliminates fire hazards when electrosurgical instruments are used. Additionally, CO2 has a high diffusion coefficient, enabling it to disperse quickly and create adequate visualization of the surgical field.

• Key characteristics of CO2 include:
  • High solubility in blood
  • Non-combustible
  • High diffusion coefficient
  • Relatively inexpensive and widely available
• During laparoscopic procedures, CO2 is typically insufflated into the peritoneal cavity at pressures between 12-15 mmHg, with flow rates of 1-2 L/min initially, then 0.2-0.4 L/min for maintenance.
• It is essential for surgeons to be aware that CO2 can cause respiratory acidosis due to absorption, so careful monitoring of end-tidal CO2 and ventilatory adjustments are necessary, as supported by the latest clinical guidelines 1.
• Alternative gases like helium, argon, or nitrous oxide are rarely used due to their inferior safety profiles compared to CO2, which remains the standard choice for pneumoperitoneum creation in laparoscopic surgery.

From the Research

Characteristics of Ideal Gas in Laparoscopic Surgery

The ideal gas for laparoscopic surgery should have several characteristics, including:

• Being non-toxic and non-flammable 2
• Not interfering with normal metabolic processes 2
• Having low solubility to decrease the amount absorbed from the peritoneal cavity 2
• Being easy to handle and clear from the body 2
• Not causing respiratory acidosis or other harmful effects 2, 3, 4

Comparison of Gases Used in Laparoscopic Surgery

Different gases have been used in laparoscopic surgery, including:

• Carbon dioxide (CO2): commonly used, but can cause respiratory acidosis and other complications 2, 3, 4, 5, 6
• Helium: proposed as a promising alternative to CO2, with fewer side effects 2
• Nitrous oxide (N2O): may be used in certain cases, but has its own set of limitations and risks 6
• Air, oxygen, and nitrogen: not recommended due to the risk of embolism and other complications 2, 6

Safety Considerations

The use of any gas in laparoscopic surgery requires careful consideration of the potential risks and complications, including:

• Gas embolism: a rare but potentially fatal complication 3, 4
• Respiratory acidosis: can occur with the use of CO2 2, 5
• Cardiac effects: can occur with the use of CO2, including arrhythmias and cardiac depression 2