Continuous Hydrogen Sulfide gas monitoring during laparoscopic or robotic surgery cannot be used a means to detect bowel injury intraoperatively using the PortaSens II Portable Gas Leak Detector Model C16 detector.

To determine the feasibility of measuring hydrogen sulfide (H₂S) gas in the insufflated abdomen during laparoscopic surgery after transmural bowel injury as a marker of unrecognized bowel injuries.

This is a feasibility study performed on swine models during a robotic training course. We aimed to determine baseline H₂S levels and subsequent elevations in H₂S levels after enterotomy of the large and small intestine.

University-based robotic training lab PATIENTS OR PARTICIPANTS: Three swine participants INTERVENTIONS: During initial insufflation of the swine abdominal cavity, baseline H₂S levels were recorded over 15-second intervals for 10 minutes using the Analytical Technology, Inc. PortaSens II Portable Gas Leak Detector Model C16. The same values were recorded in separate studies after transmural transection of the small intestine and large intestines using laparoscopic shears with and without monopolar electrosurgery.

Baseline H₂S level over the initial 10 minutes of insufflation was 0 ppm. The device is calibrated to detect levels of H₂S of 0-200 ppm. H₂S levels after small and large bowel enterotomy without monopolar electrosurgery initially showed a rise in levels of H₂S to 1-2 ppm. However, repeat confirmatory testing failed to show any elevation in H₂S levels. H₂S levels after small and large bowel enterotomy with monopolar electrosurgery both showed increases to 108 ppm and 74 ppm with a duration of elevation measuring 4:00 minutes and 4:15 minutes respectively. While our study did show elevations in H₂S after transection with monopolar electrosurgery, this was later determined to be the result of cross contamination with carbon monoxide which was a confounding factor.

Our study demonstrates that using the methodology and detection methods described, H₂S cannot be used to detect unrecognized bowel injury during laparoscopic surgery. Our results were due to cross contamination with other gases created with the use of electrosurgery and inability to reproduce initial testing which did show slight rises in H₂S levels after enterotomies without monopolar electrosurgery. Further testing of other gases produced by the gastrointestinal tract or use of alternative detection methods may provide more clinically relevant results.