Pneumoperitoneum effect on testicular oxidative stress and histopathology – Systematic review




Testis; Gonads; Injury.


Pneumoperitoneum is characterized by the presence of abdominal cavity gas. Thus, this is used as a tool to create a space in the abdominal cavity for video laparoscopic surgical procedures. However, insufflation of abdominal cavity is capable of causing damage induced by tissue ischemia and reperfusion, which is caused by hypoxia and an imbalance between free radical production and antioxidant defense system capacity. The objective of this study was to bibliographic review the negative effects of exposing healthy animals to different pneumoperitoneum settings by assessing oxidative stress and testicular histopathology, identifying intra-abdominal pressures that did not result in testicular alteration. A systematic search was carried out in three databases using the following terms: pneumoperitoneum AND testi* or gonad. The survey conducted in the databases yielded 2209 scientific articles. After applying inclusion and exclusion criteria, six papers were selected. All the articles selected addressed the effects of pneumoperitoneum on testicular structure and used at least one scoring system to perform histopathological evaluation of the testis. Three studies verified the occurrence of changes in oxidative stress. According to this literature review, pneumoperitoneum used at intra-abdominal pressures equal to, or greater than, 9 mmHg caused testicular histological damage. According to the biomarkers used in studies, pressures greater than 10 mmHg were sufficient to cause testicular oxidative stress.


Al-Maghrebi, M., Kehinde, E. O., & Anim, J. T. (2010). Long term testicular ischemia–reperfusion injury-induced apoptosis: Involvement of survivin down-regulation. Biochemical and Biophysical Research Communications, 395(3), 342–347.

Al-Maghrebi, M., Renno, W. M., & Al-Ajmi, N. (2012). Epigallocatechin-3-gallate inhibits apoptosis and protects testicular seminiferous tubules from ischemia/reperfusion-induced inflammation. Biochemical and Biophysical Research Communications, 420(2), 434–439.

Avtan, L., 2016. Creating the Pneumoperitoneum, in: Avci, C., Schiappa, J. M. (Ed.), Complications in Laparoscopic Surgery: A Guide to Prevention and Management. Springer International Publishing, 1-16.

Aydin, H. R., Kesici, S., Kesici, U., Saygin, I., Ulusoy, H., Imamoglu, M., & Deger, O. (2014). Effects of different intra-abdominal pressure values on different organs: What should be the ideal pressure? European Surgery, 46(5), 203–208.

Biler, A., Yucebilgin, S., Sendag, F., Akman, L., Akdemir, A., Ates, U., Uyanikgil, Y., Yilmaz-Dilsiz, O., & Sezer, E. (2014). The Effects of Different IntraabdominalPressure Protocols in Laparoscopic Procedureson Oxidative Stress Markers and Morphologyin Rat Ovaries. Advances in Clinical and Experimental Medicine, 23(6), 885–892.

Brun, M. V., 2015. Acesso a Cavidade Peritoneal, in: Brun, M. V.(Ed.), Videocirurgia em Pequenos Animais, 99-112.

Carden, D. L., & Granger, D. N. (2000). Pathophysiology of ischaemia-reperfusion injury. The Journal of Pathology, 190(3), 255–266.<255::AID-PATH526>3.0.CO,2-6

Čečka, F., Sotona, O., & Šubrt, Z. (2014). How to distinguish between surgical and non-surgical pneumoperitoneum? Signa Vitae, 9(1), 9.

Cosentino, M. J., Nishida, M., Rabinowitz, R., & Cockett, A. T. K. (1986). Histopathology of Prepubertal Rat Testes Subjected to Various Durations of Spermatic Cord Torsion. Journal of Andrology, 7(1), 23–31.

De Kretser, D. M., 1982. The testis, in: Austin, C.R., Short, R.V. (Eds.), Reproduction in Animals. Cambridge University Press, 76-90.

Deveney, K. E., 2006. Pulmonary Implications of CO2 Pneumoperitoneum in Minimally Invasive Surgery, in: Whelan, R. L., Fleshman Jr., J. W., et al. (Eds.), The Sage Manual: Perioperative Care in Minimally Invasive Surgery. Springer, 360-365.

Fatih, M., Huseyin, T., Orcun, C., Ilker, A., Kamil, V., Gokhan, E., Isil, A., & Ozlem, I. (2015). Comparison of intraperitoneal and intratesticular ozone therapy for the treatment of testicular ischemia-reperfusion injury in rats. Asian Journal of Andrology.

Guzmán-De La Garza, F. J., Cámara-Lemarroy, C. R., Ballesteros-Elizondo, R. G., Alarcón-Galván, G., Cordero-Pérez, P., & Fernández-Garza, N. E. (2010). Ketamine reduces intestinal injury and inflammatory cell infiltration after ischemia/reperfusion in rats. Surgery Today, 40(11), 1055–1062.

İmamoğlu, M., Çay, A., Ünsal, M. A., Aydin, S., Özdemir, O., Karahan, C., Sari, A., & Sarihan, H. (2006). The effects of increased intraabdominal pressure on testicular blood flow, oxidative stress markers, and morphology. Journal of Pediatric Surgery, 41(6), 1118–1124.

Imamoglu, M., Sapan, L., Tekelioglu, Y., & Sarihan, H. (2013). Long-term effects of elevated intra-abdominal pressure on testes an experimental model of laparoscopy. Urology Journal, 10(3), 953–959.

Istanbulluoglu, M. O., Piskin, M., Zor, M., Celik, A., Ozgok, A., Ates, M., Ustun, H., & Ozgok, Y. (2011). The Acute Effects of Increased Intra-abdominal Pressure on Testicular Tissue: An Experimental Study in Pigs. Urology, 77(2), 510.e12-510.e16.

Johnsen, S. G. (1970). Testicular Biopsy Score Count – A Method for Registration of Spermatogenesis in Human Testes: Normal Values and Results in 335 Hypogonadal Males. Hormone Research in Paediatrics, 1(1), 2–25.

Kalogeris, T., Baines, C. P., Krenz, M., & Korthuis, R. J. (2012). Cell Biology of Ischemia/Reperfusion Injury. In International Review of Cell and Molecular Biology (Vol. 298, pp. 229–317). Elsevier.

Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. UFSM.

Ribeiro, C. T., De Souza, D. B., Medeiros Jr., J. L., Costa, W. S., Pereira-Sampaio, M. A., & Sampaio, F. J. B. (2013). Pneumoperitoneum induces morphological alterations in the rat testicle. Acta Cirurgica Brasileira, 28(6), 419–422.

Rifaioglu, M. M., Davarci, M., Nacar, A., Alp, H., Celik, M., Sefil, N. K., & Inci, M. (2014). Caffeic acid phenethyl ester (CAPE) protects against acute urogenital injury following pneumoperitoneum in the rat. Renal Failure, 36(1), 98–103.

Sammour, T., Mittal, A., Loveday, B. P. T., Kahokehr, A., Phillips, A. R. J., Windsor, J. A., & Hill, A. G. (2009). Systematic review of oxidative stress associated with pneumoperitoneum. British Journal of Surgery, 96(8), 836–850.

Swanstrom, L. L., 2006. Cardiovascular Effects of CO2 Pneumoperitoneum,in: R. L. Whelan, J. W., Fleshman, J. R., et al.(Eds.), The Sage Manual: Perioperative Care in Minimally Invasive Surgery. Springer, 355-359.




How to Cite

ALMEIDA, B. A. de .; MILECH, V. .; BRUN, M. V. .; VARELA JUNIOR, A. S.; CORCINI, C. D. . Pneumoperitoneum effect on testicular oxidative stress and histopathology – Systematic review. Research, Society and Development, [S. l.], v. 10, n. 3, p. e13410313069, 2021. DOI: 10.33448/rsd-v10i3.13069. Disponível em: Acesso em: 13 apr. 2021.



Agrarian and Biological Sciences