Human Reproduction, Vol. 18, No. 4, 890,
April 2003
© 2003 European Society of Human Reproduction and Embryology
Reduction of CO2-pneumoperitoneum-induced metabolic hypoxaemia by the addition of small amounts of O2 to the CO2 in a rabbit ventilated model. A preliminary study
1 Zübeyde Hn. Women’s Hospital and Research Centre, 2 Department of Paediatric Surgery and Research Centre, 3 Department of Biomedical Engineering and 4 Department of General Surgery,Gülhane Military Medical Academy, Ankara, Turkey
5 To whom correspondence should be addressed at: Hosdere cad. Örgü sok. As apt. 2/15, Ayranci, Ankara, Turkey. e-mail: Narter{at}turk.net
Dear Sir,
We read with great interest the recent paper (Mynbaev et al., 2002
) on the reduction of CO2-pneumoperitoneum-induced metabolic hypoxaemia by the addition of small amounts of O2 to the CO2 in a rabbit ventilated model.
In the sixth paragraph of the Discussion section, the authors wrote..."the hypothesis of CO2-pneumoperitoneum induced mesothelial damage through hypoxia and its prevention by adding small amounts of O2 had been described by Yesildaglar et al. (1999, 2000), Molinas and Koninckx (2000) and Molinas et al. (2001) based on data in rabbits (Molinas and Koninckx, 2000; Yesildaglar et al., 2000) and mice (Yesildaglar et al., 1999; Molinas et al., 2001)". The mentioned publications by Yesildaglar et al. (1999, 2000) had no information, description or discussion about the prevention of mesothelial damage during pneumoperitoneum by adding small amounts of O2 to the CO2. We do not know why the authors misleadingly cited these publications. To our surprise, it seems that none of the referees who reviewed this manuscript read these articles, or even their abstracts. This kind of misinformation may cause the readers to think that the prevention of CO2-pneumoperitoneum-induced mesothelial damage by adding small amounts of O2 is already a known fact.
In the surgical protocol, the authors wrote ..."a continuous flow rate through the abdominal cavity was used to constantly remove any O2 which might have diffused from the circulation." Is there any evidence for the diffusion of O2 from the circulation to the abdominal cavity during pneumoperitoneum? If there is no evidence known by the authors, why did they give it as a reason to use a continuous flow through the abdominal cavity? Did they have any other reason to use a continuous flow?
After we read the article by Mynbaev et al. we decided to carry out a study at the research centre of Gülhane Military Medical Academy to find out whether the results of their study were reproducible and to evaluate the effects of different gases and gas mixtures used for pneumoperitoneum on arterial blood gas and acid base parameters. We have already finalized our pilot study using only T-tubes (water valves) and commercially available gases and gas mixtures. In the full study, we can accept independent investigators to observe our experiments.
We think that the addition of O2 to CO2 during endoscopic surgery in humans should be postponed until the use of this method is approved by different research teams and independent investigators.
References
Molinas, C.R. and Koninckx, P.R. (2000) Hypoxaemia induced by CO2 or helium pneumoperitoneum is a co-factor in adhesion formation in rabbits. Hum. Reprod., 15, 1758–1763.
Molinas, C.R., Mynbaev, O., Pauwels, A. Novak, P. and Koninckx, P.R. (2001) Peritoneal mesothelial hypoxia during pneumoperitoneum is a cofactor in adhesion formation in a laparoscopic mouse model. Fertil. Steril., 76, 560–567.[CrossRef][Web of Science][Medline]
Mynbaev, O.A., Molinas, C.R., Adamyan, L.V., Vanacker, B. and Koninckx, P.R. (2002) Reduction of CO(2)-pneumoperitoneum-induced metabolic hypoxaemia by the addition of small amounts of O2 to the CO2 in a rabbit ventilated model. A preliminary study. Hum. Reprod., 17, 1623–1629.
Yesildaglar, N., Ordonez, J.L., Laermans, I. and Koninckx, P.R. (1999) The mouse as a model to study adhesion formation following endoscopic surgery: a preliminary report. Hum. Reprod., 14, 55–59.
Yesildaglar, N. and Koninckx, P.R. (2000) Adhesion formation in intubated rabbits increases with high insufflation pressure during endoscopic surgery. Hum. Reprod. 15, 687–691.
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