Shakespeare's View of the Laparoscopic Pneumoperitoneum

BACKGROUND: The laparoscopic pneumoperitoneum is created and maintained in a physiologically homeostatic potential space that is 37-degrees Centigrade ((o)C) and covered by a wet film of peritoneal fluid. The currently used gas is carbon dioxide that is instilled at 21(o)C and extremely dry. Altering this privileged space is a violation of surgical safety, principles, and reason. Maintaining normal healthy conditions in their original state by humidifying and warming the gas eliminates the rub of dry gas and takes arms against a sea of troubles. DATABASE: Literature search using PubMed and Cochrane databases identifying articles focusing on laparoscopy, pneumoperitoneum, hypothermia, evaporation, desiccation, peritoneum, and morphology. CONCLUSIONS: Shakespeare's premonitions regarding the chilling effects and intentionally induced unhappy events perpetrated on the peritoneal cavity is not nor cannot come to good. The absence of water in the gas going into a wetted cavity causes perilous circumstances, resulting in evaporative hypothermia, tissue desiccation, and damage that precede adhesion formation. Providing the most protective canopy for the intraabdominal cavity with humidity and warmth prevents calamitous clinical outcomes and mirrors nature's intent. The virtue is in doing no harm.