Alternative Gases in Laparoscopic Surgery

Visualization within the peritoneal cavity requires space in which to emit light, receive the nonabsorbed light, and maneuver. In laparoscopic surgery this is accomplished by filling the peritoneal cavity with a gas that distends the abdominal wall. The history of laparoscopy is replete with efforts to use many different gases for establishing pneumoperitoneum, including room air, nitrous oxide, oxygen, and carbon dioxide. The ideal gas for pneumoperitoneum should be nontoxic, colorless, readily soluble in blood, easily ventilated through the lungs, nonflammable, and inexpensive. Carbon dioxide is the standard gas used for pneumoperitoneum. The reason for this is that both oxygen and air are not absorbed as readily and therefore are more likely to result in death if an air embolism occurs. Nitrous oxide is dangerous because of unpredictable and uncontrollable absorption into the bloodstream. Moreover, oxygen and nitrous oxide support combustion if mixed with methane and have been associated with instances of intra-abdominal explosion [1–4].