Helium and other alternative insufflation gases for laparoscopy - A review

Background: Carbon dioxide (CO2) is currently the insufflation gas of choic e for laparoscopy. It fulfills most of the requirements for an ideal insuff lation gas, being colorless, noninflammable, and rapidly excreted from the circulation. However, its use is associated with adverse cardiorespiratory effects, especially in patients with preexisting cardiorespiratory compromi se. Methods: The descriptive review of relevant literature, moreover, has been proposed that it increases the incidence of port site (wound) metastases fr om abdominal cancers when used during oncological surgery. In addition, it may cause postoperative pain due to peritoneal irritation, and its use is a ssociated with physiological and immunological impairment. Hence, there is scope for the investigation of alternative insufflation gases. Other possib ilities include gasless laparoscopy, helium, nitrous oxide, (N2O), and argo n. Results: Helium insufflation has been used extensively in animal models but only to a limited extent in humans. In experimental studies, it has been s hown to produce fewer changes in cardiorespiratory acid intraperitoneal imm unological status than CO2 insufflation, and its use is associated with les s spread of tumors to port sites in a variety of small animal tumor models. However. helium also has the potential for some adverse effects. Helium pn eumothorax probably resolves more slowly than CO2 pneumothorax, and helium gas embolism is tolerated poorly in animal models. The clinical significanc e of these potential problems has yet to be determined. Conclusions: Although the use of alternative gases appears to be promising, further evaluation is needed within both clinical and laboratory settings before their routine clinical use can be supported.