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Biomedical subjects

B Böhm

Publications and source records attributed to B Böhm.

At least 55 records · Page 3Linked to original sources
PubMed1998

Intermittent pneumatic sequential compression (ISC) of the lower extremities prevents venous stasis during laparoscopic cholecystectomy. A prospective randomized study.

BACKGROUND: Fifty patients were included in a prospective randomized trial to evaluate the efficacy of intermittent sequential compression (ISC) of the lower extremities in preventing venous stasis during laparoscopic cholecystectomy. METHODS: We treated 25 patients with (+ISC) and 25 without (-ISC) intermittent sequential compression. Peak flow velocity (PFV) and cross-sectional area (CSA) of the right femoral vein were measured by Doppler ultrasound before, during, and after capnopneumoperitoneum with 14 mm Hg. RESULTS: PFV was 26.4 (8.4) cm/s and CSA was 1.03 (0.23) cm2 before pneumoperitoneum was induced. During abdominal insufflation, PFV decreased to 61% of the baseline value in the (-ISC) group but remained unchanged in the (+ISC) group (t = 5.17, df = 42.8, p < 0.01). CSA was 1.06 (0.22) cm2 before insufflation. It increased to 118% of the baseline in the (-ISC) group and to 108% in the (+ISC) group (t = -1.55, df = 47.1, p = 0.13). PFV and CSA returned to baseline values within 5 min after abdominal desufflation. CONCLUSIONS: ISC effectively neutralizes venous stasis during laparoscopic surgery and may decrease the risk of post-operative thromboembolic complication. Therefore, it is recommended for all prolonged laparoscopic procedures.

Adult↗
PubMed1998

Influence of acute hemorrhage and pneumoperitoneum on hemodynamic and respiratory parameters.

BACKGROUND: We examined the questions of whether resuscitated (compensated) acute hemorrhage enhances the negative effects of carbopneumoperitoneum on hemodynamic and respiratory parameters and whether pneumoperitoneum with helium has any advantages under these circumstances. Our investigation focused on the influence of acute hemorrhage with different gases on the cardiovascular and respiratory system as well as on hepatic and renal blood flow in a porcine model. METHODS: Cardiac and hemodynamic function were monitored via implantation of catheters in pulmonary artery, femoral vein, and artery. Renal and hepatic blood flow were recorded using a transonic volume flow meter placed at the renal and hepatic artery and portal vein. Twelve animals were randomly assigned to one insufflation gas (carbon dioxide [CO2] or helium [He]). Following baseline recordings, acute hemorrhage (20 ml/kg) was induced by continuous bleeding over 30 min. Animals then received a colloidal solution (20 ml/kg 6% hydroxyethylstarch solution) over 30 min. Pneumoperitoneum of 12 mmHg was established, and all parameters were measured after 30 min of adaptation. The major endpoints of the study were cardiac output (CO), arterial pressure (MAP), systemic vascular resistance (SVR), and central venous pressure (CVP), as well as blood flow in hepatic and renal artery and portal vein. RESULTS: While CO and hemodynamic parameter as well as hepatic and renal blood flow were markedly reduced after hemorrhage, they returned nearly to their previous levels after resuscitation. Pneumoperitoneum with 12 mmHg did not further depress the cardiovascular system or reduce hepatic and renal blood flow. Pneumoperitoneum did not alter hepatic or renal blood flow. Pneumoperitoneum with helium did not substantially change the reaction of the cardiovascular system after resuscitated hemorrhage. CONCLUSIONS: If hemorrhage is compensated by proper resuscitation and hypovolemia is avoided, laparoscopic surgery with pneumoperitoneum of 12 mmHg appears to be not harmful. Using helium as the insufflating gas had no clear advantage over the carbon dioxide model.

Acute Disease↗
PubMed1998

Postoperative pain and fatigue after laparoscopic or conventional colorectal resections. A prospective randomized trial.

BACKGROUND: Conventional colorectal resections are associated with severe postoperative pain and prolonged fatigue. The laparoscopic approach to colorectal tumors may result in less pain as well as less fatigue, and may improve postoperative recovery after colorectal resections. METHODS: Sixty patients were included into a prospective randomized trial to determine the influence of laparoscopic (n = 30) or conventional (n = 30) resection of colorectal tumors on postoperative pain and fatigue. Major endpoints of the study were dose of morphine sulfate during patient-controlled analgesia (PCA), visual analog scale for pain while coughing (VASC), and visual analogue scale for fatigue (VASF). Efficacy of pain medication was assessed by visual analogue score at rest (VASR). RESULTS: Preoperative age, sex, stage, and localization of tumors were comparable in both groups. The PCA dose of morphine given immediately after surgery until postoperative day 4 was higher in the conventional group (median, 1.37 mg/kg; 5-95 percentile 0.71-2. 46 mg/kg) than the laparoscopic group (0.78 mg/kg; 0.24-2.38 mg/kg, p < 0.01). Postoperative VASR was comparable between both groups, but VASC was higher from the first to the seventh postoperative day (p < 0.01). Postoperative fatigue was higher after conventional than after laparoscopic surgery from the second to the seventh day (p < 0. 05). CONCLUSIONS: This study confirms that analgetic requirements are lower and pain is less intense after laparoscopic than after conventional colorectal resection. Patients also experience less fatigue after minimal invasive surgery. Because of these differences, the duration of recovery is shortened, and the postoperative quality of life is improved after laparoscopic colorectal resections.

Adult↗
PubMed1998

Influence of different trocar tips on abdominal wall penetration during laparoscopy.

Most trocars currently used to place a cannula through the abdominal wall have a conical or pyramidal tip. Because the risk of inadvertent injury along with removal of the cannula is probably related to (a) the force needed to traverse the abdominal wall, (b) the force needed to remove the trocar, and (c) the defect in the abdominal wall, the optimum configuration of the penetrating tip should be determined. The entry force needed to perforate the abdominal wall, the removal force necessary to remove the trocar, and the defect in the abdominal wall were measured in a porcine model under standardized conditions (general anesthesia, 12 mmHg pneumoperitoneum). Nineteen trocars (six disposable, seven reusable, six custom-made) have been tested. They were divided into six groups according to the shape of the tip (conical, pyramidal, or a combination). The entry force (F = 25.6, p < 0.0001) and the removal force (F = 5.1, p < 0.01) were related to the shape of the tip. Conical tips needed a higher force than purely pyramidal tips. The abdominal defect was also different between groups (F = 6.5, p < 0. 001). The trocar with a pyramidal shape caused a greater defect than conical tips. The defect in the abdominal wall was inversely related to the entry force (r = -0.55, p < 0.001) and to the removal force (r = -0.57, p < 0.001). There is not an optimum configuration of a simple push-through trocar with a low entry force and a high removal force. Some kind of a conical tip is recommended for insertion of trocars under direct view.

Abdominal Muscles↗
PubMed1998

A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report.

BACKGROUND: Uncontrolled studies using laparoscopic techniques in colorectal surgery have not demonstrated clear advantages to these procedures compared with conventional ones, and surgeons are concerned about unusual early recurrences reported after laparoscopic colorectal cancer surgery. STUDY DESIGN: We conducted a prospective, randomized trial in one surgical department comparing laparoscopic (LAP) and conventional (CON) techniques in 109 patients undergoing bowel resection for colorectal cancers or polyps. Postoperatively, all patients underwent measurement of pulmonary function tests every 12 hours, and were treated identically on a highly controlled protocol with regard to analgesic administration, feeding, and postoperative care. RESULTS: Of the 55 patients assigned to LAP and 54 to the CON group, there were 42 and 38 with cancer, respectively (the other patients had large adenomas). Overall recovery of 80% of forced expiratory volume in 1 second and forced vital capacity was a median of 3 days for LAP and 6.0 days for CON (p = 0.01). LAP patients used significantly less morphine than CON patients up to the second day after surgery (0.78 +/- 0.32 versus 0.92 +/- 0.34 mg/kg per day, p = 0.02). Flatus returned a median of 3.0 days after LAP versus 4.0 days after CON surgery (p = 0.006). Tumor margins were clear in all patients. After a median followup of 1.5 years (LAP) and 1.7 years (CON), there were no port site recurrences in the LAP group. Seven cancer-related deaths have occurred (three in the LAP group, four in the CON group). CONCLUSIONS: Within this prospective, randomized trial, laparoscopic techniques were as safe as conventional surgical techniques and offered a faster recovery of pulmonary and gastrointestinal function compared with conventional surgery for selected patients undergoing large bowel resection for cancer or polyps. There were no apparent shortterm oncologic disadvantages. Longer followup is needed to fully assess oncologic outcomes.

Adenocarcinoma↗
PubMed1998

[Endoluminal stent prosthesis implantation in thoracic aneurysm of the descending aorta--a case report].

We report on a 72-year old male with a large aneurysm of descending thoracic aorta which was treated by implantation of a Dacron-covered self-expanding Nitinol stent graft (Talent, HOSMED). The patient was unfit for surgical aneurysm resection because of generalised atherosclerosis and cardiomyopathy. We think that stent implantation for descending thoracic aortic aneurysms is an attractive alternative to surgical aneurysm resection, especially in patients with enhanced operative risk. However, further experience, and especially long term-results, are required before more widespread application of intra-luminal stent implantation in the management of thoracic aortic aneurysms can be recommended.

Aged↗
PubMed1998

[Traumatic peripheral vascular injuries].

2-4% of vascular injuries need operative reconstruction. In polytraumatized patients the rate is even 10%. Arterial vascular repair should precede venous reconstruction and orthopaedic stabilization due to limb threatening ischemia. Penetration or blunt vascular trauma result either in acute blood loss, ischemia or compartmental compression. Reperfusion syndrome leads to vital threat of patient. Clinical assessment, measurement of limb pressures using a Doppler device and use of duplex ultrasonography are reliable adjuncts in the rapid evaluation. Arteriography is rarely indicated and should be spared for patients with abnormal physical examination. Minimizing ischemia (6-8 h) is an important factor in maximizing limb salvage. Vascular repair include direct anastomosis or lateral suture repair mostly combined with primary shortening of the extremity. In most cases autogenous vein graft is required. Rethrombosis, arteriovenous fistula and pseudoaneurysms are possible complications. Stabilisation of the fracture has priority over vascular reconstruction. The initial steps to success are surgical debridement, adequate bony stabilization mostly by external fixation, revascularisation of vascular injury, immediate fascial decompression and early soft-tissue reconstruction. The best results are obtained when a multidisciplinary approach is used combining expertise in orthopedic surgery, vascular surgery and plastic surgery.

Arteries↗
PubMed1997

Effects of pneumoperitoneum with carbon dioxide, argon, or helium on hemodynamic and respiratory function.

OBJECTIVE: To evaluate the effects of pneumoperitoneum with carbon dioxide, argon, and helium; different abdominal pressures (ie, 8, 12, and 16 mm Hg); and different positions (ie, head up, head down, supine) on hemodynamic and respiratory function in a porcine model. DESIGN: Prospective randomized trial. SETTING: Animal research laboratory. ANIMALS: Eighteen pigs weighing 25.5 +/- 6.9 kg (mean +/- SD). INTERVENTIONS: General anesthesia with endotracheal intubation. Implantation of pulmonal artery catheter and central venous line in jugular vein and catheters in femoral artery and vein. Carbon dioxide, argon, or helium was insufflated through a cannula in the left upper quadrant. The type of gas was randomly assigned to each animal. After recording baseline values at the beginning and at the end without pneumoperitoneum, each animal was placed in 1 of the 3 positions and under 1 of the 3 pressures kept by the insufflator. After 15 minutes of adaptation to the new circumstances, all factors were recorded. This procedure was repeated until all 9 combinations of pressures and positions were evaluated. MAIN OUTCOME MEASURES: Cardiac output; heart rate; stroke volume; right ventricular stroke work; pressures in the pulmonal artery, vena cava, and femoral artery and vein; systemic vascular resistance; respiratory pressure; tidal volume; pH; base excess; oxygen partial pressure; and carbon dioxide partial pressure. RESULTS: The type of gas did not affect cardiac output. Only carbon dioxide demonstrated negative effects on respiratory function. Argon markedly increased afterload. Carbon dioxide increased central venous and mean arterial pressure, which was only moderate using helium. A head-up position decreased cardiac output and central venous pressure and increased mean arterial and peripheral venous pressures, which were partly compensated in a head-down position. An intraperitoneal pressure of 16 mm Hg increased peripheral and central venous pressures, heart rate, and respiratory pressure, and decreased cardiac output, tidal volume, and pH. CONCLUSIONS: Helium may be an alternative gas to establish pneumoperitoneum because it does not have any effect on respiratory function and has only a moderate effect on hemodynamic function. Argon insufflation has some hemodynamic disadvantages. An intraperitoneal pressure greater than 12 mm Hg and a head-up position should be avoided because both have a markedly negative effect on respiratory and hemodynamic factors.

Animals↗
PubMed1997

Improvements in mechanical bowel preparation for elective colorectal surgery.

PURPOSE: This study was undertaken to determine whether a mechanical bowel preparation with 2 liters of polyethylene glycol solution combined with a laxative (Group A) increases the acceptability of bowel preparation and reduces discomfort compared with 4 liters of polyethylene glycol solution (Group B). METHODS: One hundred patients undergoing an elective colorectal resection were included in a prospective, randomized study. Acceptability (nausea, vomiting, abdominal cramps, discomfort from insertion of the nasogastric tube, and anal discomfort) was assessed using visual analog scales. Efficacy of bowel lavage was scored intraoperatively by a blinded surgeon. RESULTS: Overall acceptability was 5.1 +/- 2.8 in Group A patients and 5.6 +/- 2.6 in Group B patients (P = 0.5). The incidence and visual analog score for nausea, vomiting, anal discomfort, and cramps were not different between groups. Excellent efficacy of bowel preparation was shown in 94 percent of patients in Group A and 84 percent of patients in Group B (P = 0.5). The incidence of septic complications was 2 percent in Group A patients and 12 percent in Group B patients (P = 0.06). CONCLUSION: Because the acceptability of both cleansing regimens were not different, 2 liters of polyethylene glycol plus Prepacol should be preferred because the amount of fluid administered to clean the bowel is reduced and the nasogastric tube can always be avoided.

Aged↗
PubMed1997

Intermittent sequential compression of the lower limbs prevents venous stasis in laparoscopic and conventional colorectal surgery.

PURPOSE: This study was designed to evaluate the influence of intraoperative intermittent sequential compression (ISC) on venous blood return from the lower limbs during laparoscopic and conventional colorectal colectomy. METHODS: Fifty patients undergoing laparoscopic (n = 25) or conventional (n = 25) colorectal surgery were included in a prospective study. Peak venous flow (PFV) and the cross-sectional area (CSA) of the femoral vein were assessed by Doppler ultrasound examination intraoperatively. RESULTS: Age, gender, and body mass index were comparable between both groups. Baseline PFV was 21 +/- 6.6 cm/s in the conventional and 18.4 +/- 6.4 cm/s in the laparoscopic group (P = 0.2). ISC increased PFV to 156 +/- 29 percent of the baseline value in the conventional group and to 161 +/- 29 percent in the laparoscopic group. PFV decreased after abdominal insufflation to 127 +/- 19 percent of the baseline value in the laparoscopic group and after laparotomy to 134 +/- 27 percent in the conventional group (P = 0.3). PFV decreased slightly in both groups during surgery but remained well above the baseline value. Baseline CSA was 1.02 +/- 0.17 cm2 in the conventional group and 1 +/- 0.23 cm2 in the laparoscopic group. ISC decreased CSA to 0.91 +/- 0.18 cm2 (conventional) and 0.85 +/- 0.18 cm2 (laparoscopic) after initiation of ISC. CSA was 0.92 +/- 0.18 cm2 after abdominal insufflation in the laparoscopic group, and it was 0.93 +/- 0.18 cm2 after laparotomy in the conventional group (P = 0.4). During surgery, there were no differences in absolute CSA or CSA changes compared with the baseline value in both groups. Postoperative circumference of the calf and thigh were not different between both groups. Postoperative thromboembolic complications did not occur. CONCLUSION: ISC effectively increases venous blood flow from the lower limbs during conventional and laparoscopic colorectal resections and may decrease the risk of postoperative deep vein thrombosis. Therefore, ISC is strongly recommended in every prolonged laparoscopic procedure.

Aged↗
PubMed1997

[Value of laparoscopic technique in primary colorectal carcinoma].

Patients who had undergone elective resection for primary colorectal cancer were included in a prospective study. The purpose of the study was to specify the current role of laparoscopic surgery in the treatment of colorectal cancer. Therefore, the reasons for performing the resection conventionally were documented under the general guideline that all colorectal cancer should be resected laparoscopically. Of 111 patients treated in 1995, only 22 underwent a laparoscopic resection and 4 patients a laparoscopic-assisted resection. Age, sex and tumor stage were comparable between groups. Operative time was longer in the laparoscopy group; duration of postoperative ileus and postoperative hospital stay were shorter. The most frequent indications for using a conventional approach were rectal cancer (n = 29), adhesions (n = 15), randomly selected patients (n = 14) and advanced cancer (n = 12). Cardiovascular risk factors were not so important. Laparoscopic techniques were only applied in a minority of patients with colorectal cancer (24-37%). Laparoscopic sphincter-preserving surgery is currently not recommended for rectal cancer in the middle and lower rectum. General risk factors are rarely a contraindication for a laparoscopic approach.

Aged↗
PubMed1997

[7 mm tunnel incision with lateral approach as routine intervention in cataract surgery].

UNLABELLED: As the lateral incision in comparison to the classic incision at the 12 o'clock position induces less astigmatism and shows higher wound stability, we wanted to determine if this technique could be used as a routine procedure for most patients. PATIENTS AND METHODS: A total of 186 patients were prospectively included in this study. They all had a lateral incision with the no-stitch technique, either as a clear corneal incision or as a corneoscleral or scleral incision. Postoperatively, patients were followed up for up to 12 months. RESULTS: Whereas the scleral incision showed the highest wound strength, one patient with a corneoscleral incision needed a later suture. There were two cases of endophthalmitis after a clear corneal incision; 6-12 months postoperatively the mean induced astigmatism amounted 0.64 +/- 0.22 D after a scleral incision, 0.71 +/- 0.47 D after a corneoscleral incision, and 0.92 +/- 0.63 D after a clear corneal incision. CONCLUSION: The lateral approach with a scleral is a safe procedure and induces very little astigmatism. It can be used routinely for all patients who have inverse preoperative astigmatism or none at all. The clear corneal incision shows instable wound closure and a higher infection risk. In the long term it induces an astigmatism of about 1 D and therefore is of no use for correction of higher inverse astigmatism.

Aged↗
PubMed1997

Laparoscopic resection of high rectovaginal fistula with intracorporeal colorectal anastomosis and omentoplasty.

A 46-year-old Caucasian female underwent vaginal hysterectomy for myoma in another hospital and developed a high rectovaginal fistula 6 weeks later. A diverting-loop colostomy of the sigmoid colon was performed 2 months later. The patient was admitted to our service with persistent high rectovaginal fistula 6 months later. We resected the sigmoid colon and two-thirds of the rectum including the fistula tract using laparoscopic techniques. An intracorporeal anastomosis was accomplished using a double-stapling technique. An omental flap was mobilized and placed between the colorectal anastomosis and the vagina. Except for a subcutaneous wound infection at the former colostomy site, the postoperative course was uneventful. The patient was discharged at the 7th postoperative day and remained free of symptoms. We conclude that laparoscopic resection of high rectovaginal fistula with primary intracorporeal anastomosis is feasible and should be considered in selected cases as an alternative "minimal-invasive" approach to this disease.

Anastomosis, Surgical↗
PubMed1997

Does laparoscopy increase bacteremia and endotoxemia in a peritonitis model?

BACKGROUND: Laparoscopy is increasingly used in patients with intraabdominal bacterial infection although pneumoperitoneum may increase bacteremia by elevated intraabdominal pressure. METHODS: The influence of laparotomy and laparoscopy on bacteremia, endotoxemia, and postoperative abscess formation was investigated in a rat model. Rats received intraperitoneally a standardized fecal inoculum and underwent laparotomy (n = 20), or laparoscopy (n = 20), or no further manipulation in the control group (n = 20). RESULTS: Bacteremia and endotoxemia were higher after laparotomy and laparoscopy compared to the control group (p = 0.01) 1 h after intervention. One hour after intervention, aerobic and anaerobic bacterial species were detected in the laparotomy group while only anaerobic bacteria were found in the other two groups. Although bacteremia and endotoxemia did not differ among the three groups after 1 week, the mean number of intraperitoneal abscesses was significantly higher (p < 0.05) after laparotomy (n = 10) compared with laparoscopy (n = 6) and control group (n = 5). CONCLUSION: Laparoscopy does not increase bacteremia and intraperitoneal abscess formation compared to laparotomy in an animal model of peritonitis.

Abscess↗
PubMed1997

The influence of laparotomy and laparoscopy on tumor growth in a rat model.

BACKGROUND: The effects of laparotomy and laparoscopy with different gases on subcutaneous and intraperitoneal tumor growth have not been evaluated yet. METHODS: Tumor growth of colon adenocarcinoma DHD/K12/TRb was measured in rats after laparotomy, laparoscopy with CO2 or air, and in control group. Cell kinetics were determined after incubation with carbon dioxide or air in vitro and tumor growth was measured subcutaneously and intraperitoneally after surgery in vivo. RESULTS: In vitro, tumor cell growth increased significantly after incubation with air and CO2. In vivo, intraperitoneal tumor weight was increased after laparotomy (1,203 +/- 780 mg) and after laparoscopy with air (1,085 +/- 891 mg) and with CO2 (718 +/- 690 mg) compared to control group (521 +/- 221 mg) (p < 0.05). Subcutaneous tumor growth was promoted after laparotomy (71 +/- 35 mg) and even more after laparoscopy with air (82 +/- 45 mg) and CO2 (99 +/- 55 mg) compared to control group (36 +/- 33 mg). CONCLUSIONS: Insufflation of air and CO2 promote tumor growth in vitro. In vivo, intraperitoneal tumor growth seems to be promoted primarily by intraperitoneal air and subcutaneous tumor growth by CO2.

Adenocarcinoma↗
PubMed1997

Inhibition of peritoneal tumor cell growth and implantation in laparoscopic surgery in a rat model.

BACKGROUND: The pathogenesis of portsite recurrences after laparoscopic surgery is still unknown, and a generally accepted approach to prevent tumor implantation does not exist. METHODS: The effect of taurolidine and heparin on growth of colon adenocarcinoma DHD/K12/TRb was measured in vitro and in vivo. After incubation of the cells with heparin or taurolidine or both substances, cell kinetics were determined. In a rat model (n = 60), tumor cells were administered intraperitoneally, and pneumoperitoneum was established over 30 minutes. Rats received tumor cells, tumor cells + heparin, tumor cells + taurolidine, or tumor cells + taurolidine + heparin. RESULTS: In vitro, tumor cell growth decreased after incubation with taurolidine and taurolidine/heparin. In vivo, intraperitoneal tumor weight was lower in rats receiving heparin (298 +/- 155 mg) and taurolidine (149 +/- 247 mg) compared with the control group (596 +/- 278 mg) but even less when both substances were combined (21.5 +/- 36 mg). CONCLUSION: Heparin inhibits intraperitoneal tumor growth in vivo slightly, while taurolidine causes significant decrease of tumor cell growth in vitro as well as tumor take and intraperitoneal tumor growth in vivo.

Adenocarcinoma↗
PubMed1997

Pneumoperitoneum with carbon dioxide stimulates growth of malignant colonic cells.

BACKGROUND: Port-site recurrences have often been reported after laparoscopic surgery for malignant disease, and the pathogenesis is unknown. Whether different gases used to establish pneumoperitoneum have an influence on tumor cell growth has not been investigated. METHODS: Tumor growth of colon adenocarcinoma DHD/K12/TRb was measured in a rat model after insufflation with either carbon dioxide or helium and in a control group. Tumor growth was evaluated in three experiments: (1) in vitro (n = 60), (2) ex vivo (n = 60), and (3) in vivo (n = 60). After insufflation, cell kinetics were determined in the first two experiments. In the third experiment, tumor growth was measured subcutaneously and intraperitoneally 5 weeks after insufflation. RESULTS: Tumor cell growth increased significantly after insufflation with carbon dioxide in vitro (p < 0.03) and ex vivo (p < 0.05) compared with the control group, whereas helium did not stimulate cell growth. In vivo, subcutaneous tumor growth was promoted by carbon dioxide (131 +/- 55 mg) (p < 0.01) compared with helium (35 +/- 34 mg) and the control group (36 +/- 33 mg). Total intraperitoneal tumor weight was 717 +/- 320 mg in carbon dioxide group compared with helium (549 +/- 231 mg) and control group (570 +/- 321 mg). CONCLUSIONS: The insufflation of carbon dioxide promotes tumor growth compared with helium and control in a rat model. Further studies should confirm these results before alternative gases should be recommended in laparoscopic surgery for malignant diseases.

Adenocarcinoma↗