title: Gas embolism in laparoscopic hepatectomy: what is the optimal pneumoperitoneal pressure for laparoscopic major hepatectomy?
abstract: Laparoscopic hepatectomy (LH) has become popular as a surgical treatment for liver diseases, and numerous recent studies indicate that it is safe and has advantages in selected patients. Because of the magnified view offered by the laparoscope under pneumoperitoneal pressure, LH results in less bleeding than open laparotomy. However, gas embolism is an important concern that has been discussed in the literature, and experimental studies have shown that LH is associated with a high incidence of gas embolism. Major hepatectomies are done laparoscopically in some centers, even though the risk of gas embolism is believed to be higher than for minor hepatectomy due to the wide transection plane with dissection of major hepatic veins and long operative time. At many high-volume centers, LH is performed at a pneumoperitoneal pressure less than 12 mmHg, and reports indicate that the rate of clinically severe gas embolism is low. However, more studies will be necessary to elucidate the optimal pneumoperitoneal pressure and the incidence of gas embolism during LH.
authors.affiliation: Department of Surgery, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 Japan. yotsuka@med.toho-u.ac.jp
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Otsuka
authors.forename: Toshio
authors.initials: T
authors.lastname: Katagiri
authors.forename: Jun
authors.initials: J
authors.lastname: Ishii
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Maeda
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kubota
authors.forename: Akira
authors.initials: A
authors.lastname: Tamura
authors.forename: Masaru
authors.initials: M
authors.lastname: Tsuchiya
authors.forename: Hironori
authors.initials: H
authors.lastname: Kaneko
mesh_terms: D000818:Animals; D004618:Embolism, Air / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D014943:Global Health; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D007327:Insufflation / Q000592:standards*; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D010535:Laparoscopy / Q000009:adverse effects*; D008107:Liver Diseases / Q000601:surgery*; D010529:Peritoneal Cavity / Q000503:physiopathology*; D011028:Pneumoperitoneum, Artificial / Q000592:standards*; D011312:Pressure; D012307:Risk Factors