Using Helium for Insufflation During Laparoscopy

To the Editor.  — Laparoscopic surgery requires the creation of a pneumoperitoneum to facilitate visualization and operative manipulation. Carbon dioxide traditionally has been used for this purpose because it is colorless, inexpensive, and not flammable. Laboratory investigation has shown, however, that CO₂ pneumoperitoneum can produce significant hypercapnia and respiratory acidosis.¹ Although these complications are rarely a problem in younger patients, older patients with preexisting pulmonary disease and those with increased respiratory dead space may have difficulty eliminating the CO₂ burden in spite of mechanically increased minute ventilation.²Helium has been investigated as an insufflating gas in a porcine model in our laboratory.¹ Simulation of clinical conditions demonstrated the absence of hypercapnia and the resultant respiratory acidosis observed in animals that received CO₂. We have now begun a clinical protocol, approved by our institutional review board, and wish to inform JAMA readers of the successful