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July 1, 2004

Double-blind, Prospective, Randomized Study of Warmed, Humidified Carbon Dioxide Insufflation vs Standard Carbon Dioxide for Patients Undergoing Laparoscopic Cholecystectomy

Author Affiliations

From the Departments of Surgery (Dr Farley and Ms Greenlee) and Biostatistics (Messrs Larson and Harrington), Mayo Clinic, Rochester, Minn. The authors have no financial investments in Lexion Medical. Nothing in this article implies endorsement of the products of Lexion Medical.

Arch Surg. 2004;139(7):739-744. doi:10.1001/archsurg.139.7.739

Hypothesis  Patients undergoing warmed, humidified carbon dioxide (CO2) insufflation for laparoscopic cholecystectomy will (1) maintain a warmer intraoperative core temperature, (2) have their surgeon experience less fogging of the camera lens, and (3) have less postoperative pain than patients undergoing laparoscopic cholecystectomy with standard CO2 insufflation.

Design  A double-blind, prospective, randomized study comparing patients undergoing laparoscopic cholecystectomy with standard CO2 insufflation vs those receiving warmed, humidified CO2 (Insuflow Filter Heater Hydrator; Lexion Medical, St Paul, Minn) was performed. Main variables included patient core temperature, postoperative pain, analgesic requirements, and camera lens fogging.

Results  One hundred one blinded patients (69 women, 32 men) undergoing laparoscopic cholecystectomy were randomized into 2 groups—52 receiving standard CO2 insufflation (group A) and 49 receiving warmed, humidified CO2 (group B). Mean patient intraoperative core temperature change (group A decreased by 0.03°C, group B increased by 0.29°C, P = .01) and mean abdominal pain (Likert scale, 0-10) at 14 days postoperatively (group A, 1.0; group B, 0.3; P = .02) were different. Other variables (camera lens fogging, early postoperative pain, narcotic requirements, recovery room stay, and return to normal activities) between groups were similar.

Conclusion  While patients undergoing laparoscopic cholecystectomy with warmed, humidified CO2 had several advantages that were statistically significant, no major clinically relevant differences between groups A and B were evident.