The peritoneum and the pneumoperitoneum: a review to improve clinical outcome

The pneumoperitoneum has a direct effect on the peritoneum and influences the outcome of laparoscopic surgery. The quality of the gas used, its temperature and dryness cause physical and chemical alterations that are preventable. The traditional gas is 20°C and 0.0002% relative humidity (RH). The normal peritoneal cavity condition is 36°C and virtually 100% RH. Changing the gas to a more physiologic condition of 95°C and 95% RH maintains peritoneal fluid viscosity and reduces hypothermia significantly by preventing evaporation, reduces inflammation, cell stress, and maintains peritoneal integrity by eliminating desiccation and reduces pain by preventing release of acute-phase reactive chemicals related to cell stress and disruption. Keeping peritoneal surfaces moist continuously during laparoscopy maintains a normal physiologic environment that is important to improving patient outcomes.