[Effect of carbon dioxide pneumoperitoneum during laparoscopic surgery on morphology of peritoneum].

Objective: To investigate the influence of carbon dioxide (CO2) pneumoperitoneum during laparoscopic surgery on morphology of peritoneum.

Methods: Forty patients with myoma of uterus or simple ovarian cyst excluding peritonitis were randomly divided into 2 equal groups to undergo laparoscopic surgery with CO2 pneumoperitoneum or laparotomy respectively. Specimens of parietal peritoneum were obtained at different time points, 0, 30, 90, and 120 min after the beginning of observation, i.e. e, insufflation or opening of the peritoneal cavity, to undergo transmission electron microscopy and scanning electron microscopy to observe the morphological changes of mesothelial cells.

Results: In the laparotomy group, up to the time point of 60 min, there was no marked change of mesothelial cells. Intercellular cleft were occasionally found since 90 min and became significant 120 min after. However, in the CO2 pneumoperitoneum group bulging up of mesothelial cells was evident immediately at the time of filling of CO2, intercellular spaces could be found 30 min later, 60 min later intercellular cleft deep to the underlying basement membrane could be seen and the basement membrane lost its continuity and became uncovered, and 120 min later such changes became more significant and a small amount of lymphocytes and macrophages were found in the intercellular clefts.

Conclusion: Carbon dioxide pneumoperitoneum during laparoscopic surgery causes significant morphological changes in the peritoneum duration of insufflation dependently.