Abstracts
1997 Digestive Disease Week

The detection of aerosolized cells during laparoscopy.

S Ikramuddin, EC Ellison, WJ Schirmer, J Lucas, WS Melvin. Division of General Surgery, Ohio State University, Columbus, OH.

Over the past few years a number of anecdotal reports have surfaced recording port site tumor recurrences after laparoscopic resection of a primary tumor. This unusual pattern of recurrence has been thought secondary to tumor cell aerosolization during carbon dioxide induced pneumoperitoneum. However, there has been no clear documentation of cellular aerosolization in a human model. In an effort to detect aerosolized cells, we performed the following experiment: Patients scheduled for elective laparoscopy underwent port placement and abdominal insufflation with carbon dioxide. A suction trap was then filled with 40 cc of normal saline and attached to an insufflation site on the port. The carbon dioxide effluent was allowed to bubble through the saline for the duration of the case. The specimen was concentrated by centrifuging it at 1500 rpm for 10 minutes. The cells were then resuspended and red cells lysed. Cells were suctioned onto a micropore filter and transferred to a slide. Each slide was fixed and Pap stained. In total 23 specimens were obtained. Five patients (22%) had malignant disease of which one was widely metastatic. The average sampling time was 33±14 min. In the patient with gross metastatic disease, staining revealed a large number of malignant cells. Malignant cells were found in no other patients. However, in one patient who underwent a laparoscopic cholecystectomy and two patients with hepatocellular carcinoma, aerosolized mesothelial cells were identified. We conclude that cells are aerosolized in laparoscopic surgery. In particular, malignant cells were spread in metastatic disease. The technique described can be used to further evaluate the role of cellular aerosolization in the spread of cancer.