title: Effects of portal triad clamping on haemodynamic conditions during laparoscopic liver resection.
abstract: To evaluate the haemodynamic effects of portal triad clamping (PTC) during laparoscopic liver resection, 10 patients without cardiac disease were studied by invasive monitoring including a pulmonary artery catheter and were compared with a control group of 10 patients undergoing liver resection by laparotomy. During laparoscopic surgery, intra-abdominal pressure was kept below 14 mm Hg and minute ventilation was adjusted to prevent hypercapnia. Measurements were made before PTC (T1), 5 min after PTC (T2) and 5 min after clamp release (T3). During clamping with pneumoperitoneum, mean arterial pressure (MAP) remained stable (+2%; not significant), systemic vascular resistance (SVR) increased by 37% (P<0.01, T2 vs T1) and cardiac index (CI) decreased by 19% (P<0.01, T2 vs T1). During laparotomy and clamping, MAP increased by 18% (P<0.01, T2 vs T1), SVR increased by 36% (P<0.01, T2 vs T1) and CI decreased by 9% (not significant). We were unable to demonstrate a difference in haemodynamic changes during clamping with pneumoperitoneum vs the open surgical technique, but in a small number of patients this lack of difference could have been a result of inadequate statistical power. The haemodynamic changes that we found were well tolerated in these patients, who had normal cardiac function.
authors.affiliation: Département d'Anesthésie-Réanimation, AP-HP Hôpital Henri Mondor and Université Paris XII, Créteil, France.
authors.forename: F
authors.initials: F
authors.lastname: Decailliot
authors.forename: D
authors.initials: D
authors.lastname: Cherqui
authors.forename: B
authors.initials: B
authors.lastname: Leroux
authors.forename: M
authors.initials: M
authors.lastname: Lanteri-Minet
authors.forename: S
authors.initials: S
authors.lastname: Ben Saïd
authors.forename: E
authors.initials: E
authors.lastname: Husson
authors.forename: P
authors.initials: P
authors.lastname: Duvaldestin
authors.forename: F
authors.initials: F
authors.lastname: Stéphan
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003250:Constriction; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D008102:Liver Circulation / Q000502:physiology*; D008107:Liver Diseases / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects