title: Elevated intrahepatic pressures and decreased hepatic tissue blood flow prevent gas embolus during limited laparoscopic liver resections.
abstract: BACKGROUND
  As new techniques are emerging for laparoscopic liver resections, concerns have been raised about the development of gas embolus related to the CO(2) pneumoperitoneum. We hypothesized that elevated intrahepatic vascular pressures and decreased hepatic tissue blood flow (LQB) would prevent gas embolus during laparoscopic liver resections under conventional pneumoperitoneum.
  
  
  METHODS
  Intrahepatic vascular pressures and LQB were measured in nine pigs with varying CO(2) pneumoperitoneum. Gas embolus was determined after hepatic incision by monitoring pulmonary arterial pressure (PAP), hepatic venous PCO(2), systemic blood pressure (SBP), and suprahepatic vena cava ultrasound.
  
  
  RESULTS
  As the pneumoperitoneum was increased from 0 to 15 mmHg, intrahepatic vascular pressures increased significantly (p < 0.05), while LQB decreased significantly (p < 0.05). A 2.0-cm hepatic incision at 4, 8, 15, and 20mmHg produced no ultrasound evidence of gas embolus and no changes in PAP, SBP, or hepatic venous PCO(2) (p = NS).
  
  
  CONCLUSIONS
  These data suggest that the risk of significant embolus under conventional pneumoperitoneum is minimal during laparoscopic liver resections.
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA. rocco.ricciardi@umassmed.edu
authors.forename: R
authors.initials: R
authors.lastname: Ricciardi
authors.forename: S
authors.initials: S
authors.lastname: Anwaruddin
authors.forename: B K
authors.initials: BK
authors.lastname: Schaffer
authors.forename: S H
authors.initials: SH
authors.lastname: Quarfordt
authors.forename: S E
authors.initials: SE
authors.lastname: Donohue
authors.forename: S M
authors.initials: SM
authors.lastname: Wheeler
authors.forename: K A
authors.initials: KA
authors.lastname: Gallagher
authors.forename: M P
authors.initials: MP
authors.lastname: Callery
authors.forename: D E
authors.initials: DE
authors.lastname: Litwin
authors.forename: W C
authors.initials: WC
authors.lastname: Meyers
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000009:adverse effects; D004618:Embolism, Air / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control*; D006498:Hepatectomy / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D008102:Liver Circulation / Q000187:drug effects / Q000502:physiology; D023421:Models, Animal; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000379:methods*; D011312:Pressure; D013552:Swine
chemical_list: D002245:Carbon Dioxide