Clinical Benefits of Heated and Humidified Insufflation - A Review of the Relevant Literature

Summary

A recent review of the relevant published literature reveals a variety of positive clinical effects when comparing cold and dry insufflation with heated and humidified insufflation, including the effect on core body temperature, post-operative pain and peritoneal biological response.

Key Clinical Effects

• Core temperature heat loss has been shown to be mitigated during laparoscopic procedures when using heated and humidified CO2 1,2,3,5,10.
• Post-operative pain has been shown to be decreased after using heated and humidified insufflation1,2,6,7,8.
• Heated and humidified insufflation has been shown to cause less peritoneal cellular damage, less inflammatory response, and less adhesion formation compared to cold and dry insufflation.4,9

Effect on core temperature

Hypothermia is a concern and can be a detrimental effect of standard cold and dry CO2 insufflation4. It is known to be associated with several effects such as susceptibility to wound infection, hypokalemia, impaired myocardial function and prolonged postoperative recovery4. During a literature review of clinical studies and laparoscopic procedures, authors concluded heated and humidified insufflation resulted in less heat loss than cold and dry insufflation.1,2

Effect on Postoperative pain and analgesic usage

Several clinical studies assessed postoperative pain and analgesic usage after using heated and humidified insufflation or cold and dry insufflation during general surgery, bariatric and gynecological procedures. All studies concluded there was a reduction of postoperative pain at various time points1,2,6,7,8 and some concluded less analgesic usage following use of heated and humidified insufflation. While one randomized study reported no reduction of analgesic use after laparoscopic gastric bypass8, a different double-blinded randomized controlled trial (RCT) reported decreased pain medication utilization up to 10 days post-operatively6 after lap-band procedures when heated and humidified insufflation was used.

In a gynecological double-blinded RCT clinical study it was reported that morphine demand was significantly reduced after using heated and humidified insufflation during laparoscopic assisted vaginal hysterectomy7.

Effect on Peritoneum

Research in rat models reported there was less damage to peritoneal tissue after exposure to heated and humidified insufflation vs exposure to cold and dry insufflation.4, 9 After use of cold and dry insufflation, peritoneal damage was detected through disruption of the underlying connective tissue, increased inflammatory cells and intra-abdominal adhesion formation two weeks after the procedure.4,9 In contrast, exposure to heated and humidified insufflation showed much less peritoneal damage and intra-abdominal adhesions were not found.4

Conclusion

Positive health effects have been reported with the use of heated and humidified insufflation during studies of laparoscopic procedures. Across several studies authors concluded that the usage of heated humidified vs. cold and dry insufflation reduced heat loss, reduced postoperative pain, and caused less peritoneal damage.1-10

References

1. Klugsberger et al. “Warmed, humidified carbon dioxide insufflation versus standard carbon dioxide in laparoscopic cholecystectomy: a double-blinded randomized controlled trial” Surg Endosc. 2014 Sep;28(9):2656-60.
2. Hamza et al. “Heated and Humidified Insufflation During Laparoscopic Gastric Bypass Surgery: Effect on Temperature, Postoperative Pain, and Recovery Outcomes” J Laparoendosc Adv Surg Tech A. 2005 Feb;15(1):6-12.
3. Noll et al. “Heat loss during carbon dioxide insufflation: comparison of a nebulization based humidification device with a humidification and heating system” Surg Endosc. 2012 Dec;26(12):3622-5.
4. Peng et al. “Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations” J Surg Res. 2009 Jan;151(1):40-7.
5. Schlotterbeck et al. “Cold nebulization used to prevent heat loss during laparoscopic surgery: an experimental study in pigs” Surg Endosc. 2008 Dec;22(12):2616-20.
   
6. Benavides et al. “Improved outcomes for lap-banding using the Insuflow device compared with heated-only gas” JSLS. 2009 Jul-Sep;13(3):302-5.
7. Hermann et al. “Insufflation with humidified and heated carbon dioxide in short-term laparoscopy: a double- blinded randomized controlled trial” Biomed Res Int. 2015;2015:412618.
8. Champion et al. “Prospective randomized trial of heated humidified versus cold dry carbon dioxide insufflation during laparoscopic gastric bypass” Surg Obes Relat Dis. 2006 Jul-Aug;2(4):445-9.
9. Davey et al. “The effects of insufflation conditions on rat mesothelium” Int J Inflam. 2013;2013:816283
10. Marshall et al. “Intra-operative tissue oxygen tension is increased by local insufflation of humidified-warm CO2 during open abdominal surgery in a rat model” PLoS One. 2015 Apr 2;10(4):e0122838.