Production and systemic absorption of toxic byproducts of tissue combustion during laparoscopic surgery

Background: Among the potential hazards of laparoscopic surgery using electrocautery is the intraperitoneal release and subsequent absorption of byproducts of tissue combustion. In a porcine model of laparoscopic surgery with smoke production, our aims were to assess (1) the relationship between levels of intraperitoneal carbon monoxide (CO) and systemic carboxyhemoglobin (COHb) and methemoglobin (MetHb), and (2) intraperitoneal concentrations of other noxious gases, including hydrogen cyanide (HCN), acrylonitrile (Acr), and benzene (Bzn). Methods: Seven pigs underwent laparoscopic resection of three hepatic wedges using monopolar electrocautery in a CO₂ pneumoperitoneum. Sequential arterial samples were drawn to measure COHb] and MetHb] perioperatively, while gaseous intraabdominal CO], HCN], Acr], and Bzn] were assayed intraoperatively. Results: The mean ± SEM duration of operation was 90 ± 2 min, and electrocautery was used for 68 ± 4 min. Intraabdominal CO] rose from 0 to 814 ± 200 ppm (p < 0.01) while COHb] increased from 2.9 ± 0.1% to 3.5 ± 0.1% (p < 0.001). Systemic MetHb] remained unchanged intra- and postoperatively, ranging from 0.3 to 0.7%. Intraperitoneal HCN] rose from 0 to 5.7 ± 0.7 ppm (p < 0.001). Acr], however, did not change significantly from preoperative values, ranging from 0 to 1.6 ± 1.0 ppm, and Bzn] was undetectable. Conclusions: Laparoscopic tissue combustion increases intraabdominal CO] to ``hazardous' levels leading to minimal, yet significant, elevations of COHb]. Systemic MetHb] and intraabdominal HCN], Acr], and Bzn] are not elevated to toxic levels. Production of intraperitoneal smoke during laparoscopic electrosurgery therefore may not pose a significant threat to the patient. Received: 3 April 1997/Accepted: 22 May 1997