Effect of pneumoperitoneal pressure on tumor dissemination and tumor recurrence at port-site and midline incisions

Over the past several years numerous cases of port site tumor recurrence af ter laparoscopic resection of a cancerous tissue have been reported. Possib le mechanisms for tumor seeding include tumor removal, contaminated instrum ents, pneumoperitoneum, and aerosolization of tumor cells. This experiment examined the relationship among trocar contamination, aerosolization, and t umor recurrence with increasing pneumoperitoneal pressure using a hamster m odel. Increased pneumoperitoneal pressure significantly increased both inst rument contamination and tumor recurrence at midline and port site incision s. Interestingly, increasing pneumoperitoneal pressure had no significant e ffect on the number of aerosolized tumor cells. The results reaffirm that t he use of a reduced pneumoperitoneum or gasless laparoscopy may significant ly lower port site tumor recurrence.