{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T11:31:27Z","timestamp":1765279887772,"version":"3.41.0"},"reference-count":34,"publisher":"International College of Surgeons","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:p>Warming and humidification of insufflation gas has been shown to reduce adhesion formation and tumor implantation in the laboratory setting, but clinical evidence is lacking. We aimed to test the hypothesis that warming and humidification of insufflation CO<jats:sub>2<\/jats:sub> would lead to reduced adhesion formation, and improve oncologic outcomes in laparoscopic colonic surgery. This was a 5-year follow-up of a multicenter, double-blinded, randomized, controlled trial investigating warming and humidification of insufflation gas. The study group received warmed (37\u00b0C), humidified (98%) insufflation carbon dioxide, and the control group received standard gas (19\u00b0C, 0%). All other aspects of patient care were standardized. Admissions for small bowel obstruction were recorded, as well as whether management was operative or nonoperative. Local and systemic cancer recurrence, 5-year overall survival, and cancer specific survival rates were also recorded. Eighty two patients were randomized, with 41 in each arm. Groups were well matched at baseline. There was no difference between the study and control groups in the rate of clinical small bowel obstruction (5.7% versus 0%, <jats:italic>P<\/jats:italic> 0.226); local recurrence (6.5% versus 6.1%, <jats:italic>P<\/jats:italic> 1.000); overall survival (85.7% versus 82.1%, <jats:italic>P<\/jats:italic> 0.759); or cancer-specific survival (90.3% versus 87.9%, <jats:italic>P<\/jats:italic> 1.000). Warming and humidification of insufflation CO<jats:sub>2<\/jats:sub> in laparoscopic colonic surgery does not appear to confer a clinically significant long term benefit in terms of adhesion reduction or oncological outcomes, although a much larger randomized controlled trial (RCT) would be required to confirm this. ClinicalTrials.gov Trial identifier: NCT00642005; US National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894, USA.<\/jats:p>","DOI":"10.9738\/intsurg-d-14-00210.1","type":"journal-article","created":{"date-parts":[[2015,4,15]],"date-time":"2015-04-15T20:49:52Z","timestamp":1429130992000},"page":"608-616","source":"Crossref","is-referenced-by-count":5,"title":["Five Year Follow-Up of a Randomized Controlled Trial on Warming and Humidification of Insufflation Gas in Laparoscopic Colonic Surgery\u2014Impact on Small Bowel Obstruction and Oncologic Outcomes"],"prefix":"10.9738","volume":"100","author":[{"given":"Tarik","family":"Sammour","sequence":"first","affiliation":[{"name":"Department of Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew G.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland"},{"name":"Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4721","reference":[{"issue":"6","key":"i0020-8868-100-4-608-b01","series-title":"Surg Endosc","first-page":"553","article-title":"Helium and other alternative insufflation gases for laparoscopy","volume":"15","author":"Neuhaus\n              SJ,","year":"2001","unstructured":"Neuhaus\n              SJ, \n            \n              Gupta\n              A, \n            \n              Watson\n              DI.\n            \n          \n          Helium and other alternative insufflation gases for laparoscopy. Surg Endosc2001;15(6):553\u2013560"},{"issue":"1","key":"i0020-8868-100-4-608-b02","series-title":"Surg Endosc","first-page":"153","article-title":"Heating and humidifying of carbon dioxide during pneumoperitoneum is not indicated: a prospective randomized trial","volume":"20","author":"Davis\n              SS,","year":"2006","unstructured":"Davis\n              SS, \n            \n              Mikami\n              DJ, \n            \n              Newlin\n              M, \n            \n              Needleman\n              BJ, \n            \n              Barrett\n              MS, \n            \n              Fries\n              R\n            \n            et al\n          . Heating and humidifying of carbon dioxide during pneumoperitoneum is not indicated: a prospective randomized trial. Surg Endosc2006;20(1):153\u2013158"},{"issue":"2","key":"i0020-8868-100-4-608-b03","series-title":"Surg Endosc","first-page":"101","article-title":"Humidified gas prevents hypothermia induced by laparoscopic insufflation: a randomized controlled study in a pig model","volume":"13","author":"Bessell\n              JR,","year":"1999","unstructured":"Bessell\n              JR, \n            \n              Ludbrook\n              G, \n            \n              Millard\n              SH, \n            \n              Baxter\n              PS, \n            \n              Ubhi\n              SS, \n            \n              Maddern\n              GJ.\n            \n          \n          Humidified gas prevents hypothermia induced by laparoscopic insufflation: a randomized controlled study in a pig model. Surg Endosc1999;13(2):101\u2013105"},{"issue":"4","key":"i0020-8868-100-4-608-b04","series-title":"JSLS","first-page":"321","article-title":"Reduction of laparoscopic-induced hypothermia, postoperative pain and recovery room length of stay by pre-conditioning gas with the Insuflow device: a prospective randomized controlled multi-center study","volume":"2","author":"Ott\n              DE,","year":"1998","unstructured":"Ott\n              DE, \n            \n              Reich\n              H, \n            \n              Love\n              B, \n            \n              McCorvey\n              R, \n            \n              Toledo\n              A, \n            \n              Liu\n              CY\n            \n            et al\n          . Reduction of laparoscopic-induced hypothermia, postoperative pain and recovery room length of stay by pre-conditioning gas with the Insuflow device: a prospective randomized controlled multi-center study. JSLS1998;2(4):321\u2013329"},{"issue":"5","key":"i0020-8868-100-4-608-b05","series-title":"J Laparoendosc Adv Surg Tech A","first-page":"355","article-title":"Impact of temperature and humidity of carbon dioxide pneumoperitoneum on body temperature and peritoneal morphology","volume":"12","author":"Hazebroek\n              EJ,","year":"2002","unstructured":"Hazebroek\n              EJ, \n            \n              Schreve\n              MA, \n            \n              Visser\n              P, \n            \n              De Bruin\n              RW, \n            \n              Marquet\n              RL, \n            \n              Bonjer\n              HJ.\n            \n          \n          Impact of temperature and humidity of carbon dioxide pneumoperitoneum on body temperature and peritoneal morphology. 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Surg Laparosc Endosc Percutan Tech2008;18(6):539\u2013546"},{"issue":"8","key":"i0020-8868-100-4-608-b07","series-title":"Br J Surg","first-page":"950","article-title":"Meta-analysis of the effect of warm humidified insufflation on pain after laparoscopy","volume":"95","author":"Sammour\n              T,","year":"2008","unstructured":"Sammour\n              T, \n            \n              Kahokehr\n              A, \n            \n              Hill\n              AG.\n            \n          \n          Meta-analysis of the effect of warm humidified insufflation on pain after laparoscopy. 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Ann Surg2013;257(1):44\u201353"},{"key":"i0020-8868-100-4-608-b10","series-title":"Cochrane Database Syst Rev","first-page":"CD007821","article-title":"Heated CO(2) with or without humidification for minimally invasive abdominal surgery","volume":"1","author":"Birch\n              DW,","year":"2011","unstructured":"Birch\n              DW, \n            \n              Manouchehri\n              N, \n            \n              Shi\n              X, \n            \n              Hadi\n              G, \n            \n              Karmali\n              S.\n            \n          \n          Heated CO(2) with or without humidification for minimally invasive abdominal surgery. Cochrane Database Syst Rev2011;(1):CD007821"},{"issue":"6","key":"i0020-8868-100-4-608-b11","series-title":"Hum Reprod","first-page":"1473","article-title":"Prevention of adhesion formation in a laparoscopic mouse model should combine local treatment with peritoneal cavity conditioning","volume":"24","author":"Binda\n              MM,","year":"2009","unstructured":"Binda\n              MM, \n            \n              Koninckx\n              PR.\n            \n          \n          Prevention of adhesion formation in a laparoscopic mouse model should combine local treatment with peritoneal cavity conditioning. Hum Reprod2009;24(6):1473\u20131479"},{"issue":"4","key":"i0020-8868-100-4-608-b12","series-title":"Am J Obstet Gynecol","first-page":"392.e1","article-title":"Intraperitoneal temperature and desiccation during endoscopic surgery. Intraoperative humidification and cooling of the peritoneal cavity can reduce adhesions","volume":"205","author":"Corona\n              R,","year":"2011","unstructured":"Corona\n              R, \n            \n              Verguts\n              J, \n            \n              Koninckx\n              R, \n            \n              Mailova\n              K, \n            \n              Binda\n              MM, \n            \n              Koninckx\n              PR.\n            \n          \n          Intraperitoneal temperature and desiccation during endoscopic surgery. Intraoperative humidification and cooling of the peritoneal cavity can reduce adhesions. Am J Obstet Gynecol2011;205(4):392.e1\u2013e7"},{"issue":"7","key":"i0020-8868-100-4-608-b13","series-title":"Surg Today","first-page":"1328","article-title":"Conditioning of the abdominal cavity reduces tumor implantation in a laparoscopic mouse model","volume":"44","author":"Binda\n              MM,","year":"2014","unstructured":"Binda\n              MM, \n            \n              Corona\n              R, \n            \n              Amant\n              F, \n            \n              Koninckx\n              PR.\n            \n          \n          Conditioning of the abdominal cavity reduces tumor implantation in a laparoscopic mouse model. 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Auckland, New Zealand: Fisher & Paykel Healthcare Ltd;2008"},{"issue":"2 Suppl","key":"i0020-8868-100-4-608-b17","series-title":"Am J Clin Nutr","first-page":"366","article-title":"Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients","volume":"47","author":"Buzby\n              GP,","year":"1988","unstructured":"Buzby\n              GP, \n            \n              Knox\n              LS, \n            \n              Crosby\n              LO, \n            \n              Eisenberg\n              JM, \n            \n              Haakenson\n              CM, \n            \n              McNeal\n              GE\n            \n            et al\n          . Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients. 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Ann Surg2009;250(2):187\u2013196"},{"key":"i0020-8868-100-4-608-b19","series-title":"Behav Res Meth","first-page":"175","article-title":"G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul\n              F,","year":"2007","unstructured":"Faul\n              F, \n            \n              Erdfelder\n              E, \n            \n              Lang\n              A, \n            \n              Buchner\n              A.\n            \n          \n          G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. 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Ann Intern Med2001;134(8):657\u2013662"},{"issue":"1","key":"i0020-8868-100-4-608-b21","series-title":"J Ovarian Res","first-page":"90","article-title":"Peritoneal full-conditioning reduces postoperative adhesions and pain: a randomised controlled trial in deep endometriosis surgery","volume":"6","author":"Koninckx\n              PR,","year":"2013","unstructured":"Koninckx\n              PR, \n            \n              Corona\n              R, \n            \n              Timmerman\n              D, \n            \n              Verguts\n              J, \n            \n              Adamyan\n              L.\n            \n          \n          Peritoneal full-conditioning reduces postoperative adhesions and pain: a randomised controlled trial in deep endometriosis surgery. J Ovarian Res2013;6(1):90"},{"issue":"1","key":"i0020-8868-100-4-608-b22","series-title":"J Surg Res","first-page":"40","article-title":"Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations","volume":"151","author":"Peng\n              Y,","year":"2009","unstructured":"Peng\n              Y, \n            \n              Zheng\n              M, \n            \n              Ye\n              Q, \n            \n              Chen\n              X, \n            \n              Yu\n              B, \n            \n              Liu\n              B.\n            \n          \n          Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations. J Surg Res2009;151(1):40\u201347"},{"issue":"1","key":"i0020-8868-100-4-608-b23","series-title":"Fertil Steril","first-page":"166","article-title":"Effect of desiccation and temperature during laparoscopy on adhesion formation in mice","volume":"86","author":"Binda\n              MM,","year":"2006","unstructured":"Binda\n              MM, \n            \n              Molinas\n              CR, \n            \n              Hansen\n              P, \n            \n              Koninckx\n              PR.\n            \n          \n          Effect of desiccation and temperature during laparoscopy on adhesion formation in mice. 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Surg Endosc2008;22(2):287\u2013297"},{"issue":"5","key":"i0020-8868-100-4-608-b27","series-title":"Ann Surg","first-page":"792","article-title":"Major abdominal surgery increases plasma levels of vascular endothelial growth factor: open more so than minimally invasive methods","volume":"244","author":"Belizon\n              A,","year":"2006","unstructured":"Belizon\n              A, \n            \n              Balik\n              E, \n            \n              Feingold\n              DL, \n            \n              Bessler\n              M, \n            \n              Arnell\n              TD, \n            \n              Forde\n              KA\n            \n            et al\n          . Major abdominal surgery increases plasma levels of vascular endothelial growth factor: open more so than minimally invasive methods. Ann Surg2006;244(5):792\u2013798"},{"issue":"1","key":"i0020-8868-100-4-608-b28","series-title":"Dis Colon Rectum","first-page":"144","article-title":"Minimal access colorectal surgery: is it truly minimally invasive","volume":"49","author":"Hill\n              A,","year":"2006","unstructured":"Hill\n              A, \n            \n              Connolly\n              A.\n            \n          \n          Minimal access colorectal surgery: is it truly minimally invasive? Dis Colon Rectum2006;49:(1):144\u2013145"},{"issue":"9","key":"i0020-8868-100-4-608-b29","series-title":"ANZ J Surg","first-page":"821","article-title":"Differential production of cytokines following colorectal surgery","volume":"76","author":"Chuang\n              D,","year":"2006","unstructured":"Chuang\n              D, \n            \n              Paddison\n              JS, \n            \n              Booth\n              RJ, \n            \n              Hill\n              AG.\n            \n          \n          Differential production of cytokines following colorectal surgery. ANZ J Surg2006;76(9):821\u2013824"},{"issue":"2","key":"i0020-8868-100-4-608-b30","series-title":"J Surg Res","first-page":"278","article-title":"A prospective case-control study of the local and systemic cytokine response after laparoscopic versus open colonic surgery","volume":"173","author":"Sammour\n              T,","year":"2012","unstructured":"Sammour\n              T, \n            \n              Kahokehr\n              A, \n            \n              Zargar-Shoshtari\n              K, \n            \n              Hill\n              AG.\n            \n          \n          A prospective case-control study of the local and systemic cytokine response after laparoscopic versus open colonic surgery. J Surg Res2012;173(2):278\u2013285"},{"issue":"4","key":"i0020-8868-100-4-608-b31","series-title":"Aust N Z J Obstet Gynaecol","first-page":"356","article-title":"Comparison of the adhesion scoring systems used in animal models and assessment of interobserver reproducibility","volume":"46","author":"Demirturk\n              F,","year":"2006","unstructured":"Demirturk\n              F, \n            \n              Aytan\n              H, \n            \n              Caliskan\n              AC.\n            \n          \n          Comparison of the adhesion scoring systems used in animal models and assessment of interobserver reproducibility. Aust N Z J Obstet Gynaecol2006;46(4):356\u2013359"},{"key":"i0020-8868-100-4-608-b32","series-title":"Peritoneal Surgery","first-page":"459","article-title":"Animal adhesion models: design, variables, and relevance","author":"Wiseman\n              D.","year":"2000","unstructured":"Wiseman\n              D.\n            \n          \n          Animal adhesion models: design, variables, and relevance. In: diZeregaG, ed. Peritoneal Surgery. New York, NY: Springer, 2000:459\u2013476"},{"issue":"11","key":"i0020-8868-100-4-608-b33","series-title":"Hum Reprod","first-page":"2626","article-title":"Effect of temperature upon adhesion formation in a laparoscopic mouse model","volume":"19","author":"Binda\n              MM,","year":"2004","unstructured":"Binda\n              MM, \n            \n              Molinas\n              CR, \n            \n              Mailova\n              K, \n            \n              Koninckx\n              PR.\n            \n          \n          Effect of temperature upon adhesion formation in a laparoscopic mouse model. Hum Reprod2004;19(11):2626\u20132632"},{"issue":"6","key":"i0020-8868-100-4-608-b34","series-title":"Fertil Steril","first-page":"1777","article-title":"Addition of nitrous oxide to the carbon dioxide pneumoperitoneum strongly decreases adhesion formation and the dose-dependent adhesiogenic effect of blood in a laparoscopic mouse model","volume":"100","author":"Corona\n              R,","year":"2013","unstructured":"Corona\n              R, \n            \n              Binda\n              MM, \n            \n              Mailova\n              K, \n            \n              Verguts\n              J, \n            \n              Koninckx\n              PR.\n            \n          \n          Addition of nitrous oxide to the carbon dioxide pneumoperitoneum strongly decreases adhesion formation and the dose-dependent adhesiogenic effect of blood in a laparoscopic mouse model. 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