Annals of Coloproctology

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Original Articles

Effects of Intraoperative Insufflation With Warmed, Humidified CO₂ during Abdominal Surgery: A Review: Ju Yong Cheong, Anil Keshava, Paul Witting, Christopher John Young; Ann Coloproctol. 2018;34(3):125-137. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2017.09.26

12,410 View
178 Download
13 Web of Science
14 Citations

Purpose
During a laparotomy, the peritoneum is exposed to the cold, dry ambient air of the operating room (20°C, 0%–5% relative humidity). The aim of this review is to determine whether the use of humidified and/or warmed CO₂ in the intraperitoneal environment during open or laparoscopic operations influences postoperative outcomes.
Methods
A review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, OVID MEDLINE, Cochrane Central Register of Controlled Trials and Embase databases were searched for articles published between 1980 and 2016 (October). Comparative studies on humans or nonhuman animals that involved randomized controlled trials (RCTs) or prospective cohort studies were included. Both laparotomy and laparoscopic studies were included. The primary outcomes identified were peritoneal inflammation, core body temperature, and postoperative pain.
Results
The literature search identified 37 articles for analysis, including 30 RCTs, 7 prospective cohort studies, 23 human studies, and 14 animal studies. Four studies found that compared with warmed/humidified CO₂, cold, dry CO₂ resulted in significant peritoneal injury, with greater lymphocytic infiltration, higher proinflammatory cytokine levels and peritoneal adhesion formation. Seven of 15 human RCTs reported a significantly higher core body temperature in the warmed, humidified CO₂ group than in the cold, dry CO₂ group. Seven human RCTs found lower postoperative pain with the use of humidified, warmed CO₂.
Conclusion
While evidence supporting the benefits of using humidified and warmed CO₂ can be found in the literature, a large human RCT is required to validate these findings.

Citations

Citations to this article as recorded by

The effects of warmed carbon dioxide pneumoperitoneum nursing care on core body temperature, acid-base balance, and lymphocytes in older patients with cancer in Korea: a randomized controlled trial
Hyosun Park, Nayeon Shin, Jeong-Heum Baek
Journal of Korean Biological Nursing Science.2025; 27(4): 598. CrossRef
Performance of intraoperative surgical smoke management technologies for laparoscopic surgery: A comparative in-vivo pig study
Daniel Göhler, Levon Aslanyan, Kathrin Oelschlägel, Petru Bucur, Jonathan Buggisch, Nadia Azhari, Andreas Rudolph, Sébastien Roger, Michael Stintz, Dirk Bausch, Cédric Demtröder, Mehdi Ouaissi, Urs Giger-Pabst
Journal of Aerosol Science.2024; 177: 106309. CrossRef
Does intra‐operative humidification with warmed CO2 reduce surgical site infection in open colorectal surgery? A randomized control trial
Asiri Arachchi, Alice Lee, Manisha Metlapalli, Ellathios Antoniou, Ruben Rajan, Vignesh Narasimhan, Ashray Rajagopalan, Seraphina Key, William M. K. Teoh, Thang Chien Nguyen, James Tow‐Hing Lim, Hanumant Chouhan, Bruce P. Waxman, Julian A. Smith
ANZ Journal of Surgery.2023; 93(4): 970. CrossRef
The effects of CO2 pneumoperitoneum at different temperature and humidity on hemodynamic and respiratory parameters and postoperative pain in gynecological laparoscopic surgery: A prospective randomized controlled study
Ilkben Gunusen, Ali Akdemir, Asuman Sargın, Semra Karaman
Asian Journal of Surgery.2022; 45(1): 154. CrossRef
Incidence of inadvertent perioperative hypothermia in pediatric laparoscopic surgery: a prospective observational single-center study.
Recai DAĞLI, Ülgen ÇELTİK, Fatma ÇELİK, Zeynel Abidin ERBESLER, Zeynep KÖYLÜ
Ahi Evran Medical Journal.2022;[Epub] CrossRef
Effects of Warmed and Humidified CO2 Surgical Site Insufflation in a Novel Experimental Model of Magnetic Compression Colonic Anastomosis
Francesco Marchegiani, Eric Noll, Pietro Riva, Seong-Ho Kong, Paola Saccomandi, Giorgia Vita, Véronique Lindner, Izzie Jacques Namer, Jacques Marescaux, Pierre Diemunsch, Michele Diana
Surgical Innovation.2021; 28(1): 7. CrossRef
Does the Laminar Airflow System Affect the Development of Perioperative Hypothermia? A Randomized Clinical Trial
Recai Dagli, Fatma Çelik, Hüseyin Özden, Serdar Şahin
HERD: Health Environments Research & Design Journal.2021; 14(3): 202. CrossRef
Randomized clinical trial of the effect of intraoperative humidified carbon dioxide insufflation in open laparotomy for colorectal resection
J. Y. Cheong, B. Chami, G. M. Fong, X. S. Wang, A. Keshava, C. J. Young, P. Witting
BJS Open.2020; 4(1): 45. CrossRef
The Pathogenesis and Prevention of Port-Site Metastasis in Gynecologic Oncology

Qianqian Gao, Ling Guo, Bo Wang
Cancer Management and Research.2020; Volume 12: 9655. CrossRef
Morpheus and the Underworld—Interventions to Reduce the Risks of Opioid Use After Surgery: ORADEs, Dependence, Cancer Progression, and Anastomotic Leakage
Robert Beaumont Wilson
Journal of Gastrointestinal Surgery.2019; 23(6): 1240. CrossRef
Effects of a multifaceted individualized pneumoperitoneum strategy in elderly patients undergoing laparoscopic colorectal surgery
Liping Liu, Na Lv, Chunmiao Hou
Medicine.2019; 98(14): e15112. CrossRef
Single‐incision laparoscopic reversal of Hartmann's operation through the stoma site: comparative outcomes with conventional laparoscopic and open surgery
P. Thambi, D. W. Borowski, R. Sathasivam, R.‐B. Obuobi, Y. K. S. Viswanath, T. S. Gill
Colorectal Disease.2019; 21(7): 833. CrossRef
Clinical effects of warmed humidified carbon dioxide insufflation in infants undergoing major laparoscopic surgery
Tong Meng-Meng, Xu Xue-Jun, Bao Xiao-Hong
Medicine.2019; 98(27): e16151. CrossRef
Effect of different carbon dioxide (CO2) insufflation for laparoscopic colorectal surgery in elderly patients
Rongjuan Jiang, Yan Sun, Huaiming Wang, Min Liang, Xianfeng Xie
Medicine.2019; 98(41): e17520. CrossRef

Hand-Assisted Laparoscopic Surgery: A Versatile Tool for Colorectal Surgeons: Ju Yong Cheong, Christopher J. Young; Ann Coloproctol. 2017;33(4):125-129. Published online August 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.4.125

7,073 View
69 Download
8 Web of Science
7 Citations

Abstract PDF

Purpose

Hand-assisted laparoscopic surgery (HALS) is a minimally invasive surgical technique with the combined benefits of laparoscopic surgery while allowing the use of the surgeon's hand for better tactile control. Obesity has been associated with higher conversion rates with multiport laparoscopic surgery, but not with HALS. This study aimed to examine the versatility of HALS in various clinical contexts.

Methods

All HALSs performed at 2 major tertiary centers in Sydney were prospectively collected for retrospective analysis. Variables including age, sex, body mass index (BMI), previous surgeries, pathologies including size and T-stage, and the number of conversions to a midline laparotomy were examined.

Results

A total of 121 HALS colorectal resections were analyzed. The median age of the patients was 62 years, with 63.6% being women. Seven patients required conversion to a midline laparotomy. Of the 121 patients, 50.2% were overweight or obese, and 52.9% had undergone previous abdominal/pelvic operations. However, neither obesity nor abdominal adhesions from previous operations were an indication for conversion to an open laparotomy in any of the 7 converted patients. The presence of intra-abdominal adhesions did not impact the operative time. HALS allowed access to the entire colon and rectum and allowed resection of the bladder, uterus, and ureter, when these organs were involved.

Conclusion

HALS is a versatile, minimally invasive technique, which is independent of the patient's BMI, for performing a colorectal resection.

Citations

Citations to this article as recorded by

Hand-assisted Laparoscopic Surgery (HALS) as an Alternative to Laparoscopic Converted to Open Surgery (LCOS) in Proctectomy Patients
Stephanie S. Hyon, Jana K. Elsawwah, Rahul Narang, Patricia B. Stopper, Rolando H. Rolandelli, Zoltan H. Nemeth
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2026;[Epub] CrossRef
Hand-Assisted Laparoscopic Surgery (HALS) as an Alternative to Unplanned Laparoscopic Conversion to Open Surgery (LCOS) in Colectomies for Acute Diverticulitis
Satyam K. Ghodasara, Jana K. Elsawwah, Stephanie S. Hyon, Joseph S. Flanagan, Patricia B. Stopper, Rolando H. Rolandelli, Zoltan H. Nemeth
Surgical Innovation.2025; 32(3): 222. CrossRef
Comparative clinical efficacy of three surgical modalities for the treatment of malignant tumours of the left hemicolon
Hao Chen, Dong-Ping Han, Jian-Yang Xiong, Zhen-Sheng Li, Teng-Cheng Hu, Zheng-Rong Li, Yi Cao
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Usefulness of Hand-assisted Laparoscopic Restorative Proctocolectomy for Ulcerative Colitis in the Era of Laparoscopic Surgery - A Single-center Observational Study
Hideaki Kimura, Kenichiro Toritani, Itaru Endo
Journal of the Anus, Rectum and Colon.2024; 8(3): 228. CrossRef
A single centre audit: repeat pre‐operative colonoscopy
Michelle Zhiyun Chen, Hareshdeva Devan Nair, Apoorva Saboo, Sharon Chih Lin Lee, Xinchen Gu, Sheik Mohammad Azhar Auckloo, Sandeep Tamang, Sally Jiasi Chen, Ryan William Lowe, Neil Strugnell
ANZ Journal of Surgery.2022; 92(10): 2571. CrossRef
Application of Laparoscopy in Comprehensive Staging Operation of Ovarian Cancer Based on Electronic Medical Blockchain Technology
Limei Zhang, Xinrui Li, Yao Ning, Yufei Cai, Zhihan Lv
Journal of Healthcare Engineering.2021; 2021: 1. CrossRef
Need for Reappraisal of Hand-Assisted Laparoscopic Surgery for Colorectal Diseases in the Era of Desiring Small Incisions
Chang-Nam Kim
Annals of Coloproctology.2017; 33(4): 119. CrossRef

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