Laparoscopic parenchymal division of the liver in a porcine model: comparison of the efficacy and safety of three different techniques.
BACKGROUND
Bleeding is a known and CO2 embolization a suggested risk factor for increased morbidity after laparoscopic liver resection. Devices for laparoscopic liver parenchymal transection must be evaluated for safety in this context.


METHODS
Twelve piglets underwent laparoscopic surgery during CO2 pneumoperitoneum, each animal receiving three 6 cm long transections into the liver parenchyma made with ultrasonic dissector, ultrasonic shears and vessel sealing system, respectively. Endpoints were bleeding, operation time and gas embolization. The transections and embolization events, evaluated with transesophageal echocardiography, were video recorded. Bleeding and embolization were also assessed on video tapes and operating time measured. Arterial blood gases were recorded on line.


RESULTS
The ultrasonic dissector was least advantageous in terms of bleeding and operation time. Gas embolization was more frequent with the vessel sealing system than with the ultrasonic dissector and ultrasonic shears. During two episodes of gas embolization, pCO2 increased and pO2 and pH decreased.


CONCLUSIONS
Use of all three devices is feasible. Bleeding and operation time are greatest with the ultrasonic dissector. Gas embolization occurs during transection, though in most instances it is completely harmless. Laparoscopic liver surgery with these techniques used may pose a risk of gas embolization with clinical implications. Monitoring for such events is probably to be recommended.
Jersenius
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Section of Surgery, Department of Molecular Medicine and Surgery, Karolinska University Hospital Huddinge, Karolinska Institute, SE-171 76, Stockholm, Sweden. ulf.jersenius@karolinska.se
Fors
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Rubertsson
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Arvidsson
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D000704:Analysis of Variance; D000818:Animals; D001784:Blood Gas Analysis; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004195:Disease Models, Animal; D017548:Echocardiography, Transesophageal; D004618:Embolism, Air / Q000517:prevention & control*; D004869:Equipment Safety; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000379:methods; D011336:Probability; D012680:Sensitivity and Specificity; D013552:Swine