Elevated intrahepatic pressures and decreased hepatic tissue blood flow prevent gas embolus during limited laparoscopic liver resections.
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.
Ricciardi
R
R
Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA. rocco.ricciardi@umassmed.edu
Anwaruddin
S
S
Schaffer
B K
BK
Quarfordt
S H
SH
Donohue
S E
SE
Wheeler
S M
SM
Gallagher
K A
KA
Callery
M P
MP
Litwin
D E
DE
Meyers
W C
WC
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
D002245:Carbon Dioxide