Background

Laparoscopic insufflators utilizing C02 insufflated at room temperature often result in fogging of the laparoscopic necessitating frequent removal of the the laparoscopic lens and application of an antifog solution to maintain optimal visualization. After the introduction of a high flow insufflator capable of incorporating continuous humidified C02 at our institution, we compared the incidence of critical fogging that occurred between procedures that were done with a traditional room temperature insufflator and an insufflator capable of providing humidifed C02.

Methods

25 patients undergoing RYGB and sleeve gastrectomy were randomly selected from a pool of over 100 operations that had been recorded and archived at our institution. Insufflators utiliized on these 25 patients were standard room temperature insufflators using non humidified or heated C02. The second cohort of 25 patients were randomly selected from a pool of over 100 RYGB and sleeve gastrectomy cases which were also archived at our institution but had utlized an insufflation system capable of providing continuous humidfied C02 during the laparoscopic procedure.

Results

All 50 cases were reviewed by two surgeons and the frequency and duration of scope removal and application of antifog solution was recorded. Smudging that had occured during scope transfers to various trocars during the performance of each operation were excluded. The incidence of spontaneous fogging that requred application of an antifog solution were compared between the two groups

Conclusions

Utilization of humidfied insufflated CO2 resulted in decreased episodes of scope removal and decreased application of antifog solution during laparoscopic RYGB and sleeve gastrectomy.