REPRODUCTIVE MEDICINE Antioxidant prophylaxis for cellular injury in ovarian surface epithelium resulting from CO 2 pneumoperitoneum in a laparoscopic rat model Sule Kıray • Gogsen Onalan • Gulten Karabay • Hulusi Zeyneloglu • Esra Kuscu Received: 15 February 2011 / Accepted: 5 May 2011 / Published online: 27 May 2011 Ó Springer-Verlag 2011 Abstract Objective Selective cytoprotective functions of vitamin E, N-acetyl-L-cysteine, and amifostine have been used as a preventer of ischemia injury by expelling the free oxygen radicals leading to stabilization of the cellular membranes. The purpose of this experimental study was to investigate the oxidative stress related to cellular injury in ovarian surface epithelium and the effect of prophylaxis with an anti-oxidant using laparoscopic rat model. Design Laparoscopic rat model. Materials and methods Randomly allocated 40 Wistar Albino female rats have been used for the pneumoperito- neum model which was constituted to fix the intraabdom- inal pressure on 5 mmHg for 60 min. The antioxidants, vitamin E and NAC were given to rats 3 days before the operation and were applied for 30 days; amifostine was applied 30 min before the operation until after for 7 days. After abdominal desufflation, over biopsies were made on the 13th min, 24th h, and 7th and 30th days. By using of transmission electron microscopy, the damage on cells and organels were assessed and graded. Results In ovarian surface epithelium, the apical surface specializations were affected in all groups except Vit E group:The microvilli were irregular and coarse and had disappeared in some places. Some cells were separated from the epithelium. In addition, mitochondria degenera- tion was observed in all group except Vit E. Conclusions In the early period of laparoscopy, revers- ible cellular damage occurs and this damage can be pre- vented by vitamin E. Keywords Laparoscopy Á Ovarian surface epithelium Á CO 2 pneumoperitoneum Á Rat Á Antioxidant Á Vitamin E Á Amifostine Introduction During laparoscopic surgery, for the induction of pneu- moperitoneum the pressures necessary to provide suffi- cient intra-abdominal operational space (10–15 mmHg) are usually higher than the normal physiological portal system circulation pressure (7–10 mmHg), and reduce micro- and macro-circulation of the abdominal organs and tissues, leading to hypoxia–anoxia especially in splanchnic organs, including the small intestine, liver, and kidneys [1]. In addition to this ischemic-hypoxic period, following deflation, which restores visceral perfusion of organs with oxygenated blood, the generation of reactive oxygen-free radicals causes a second-hit to the cell, leading to cell death by both apoptosis and necrosis (and likely inter- mediate forms of cell death, as well) [1, 2]. As a result, laparoscopic procedures may cause I/R injury in the abdominal organs and tissues in a time- and pressure- dependent manner [3]. Insufflation with the inert gas helium [4], gasless surgery [5], the ‘dial-down’ approach [6], preventing the head-up position [4], intravascular volume expansion[7], use of an intermittent sequential pneumatic compression device [8], and ischemic preconditioning [9] are the various practical strategies that have been investigated for prevention of pneumoperitoneum-induced oxidative stress. S. Kıray Á G. Onalan (&) Á H. Zeyneloglu Á E. Kuscu Department of Obstetrics and Gynecology, Baskent University School of Medicine, Kubilay Sok no: 36 Maltepe, 06570 Ankara, Turkey e-mail: gogsenonalan@yahoo.com G. Karabay Department of Histology, Baskent University, Ankara, Turkey 123 Arch Gynecol Obstet (2011) 284:765–772 DOI 10.1007/s00404-011-1933-7