title: Efficacy of occlusion of hepatic artery and risk of carbon dioxide gas embolism during laparoscopic hepatectomy in a pig model.
abstract: BACKGROUND
  The important point in safely performing laparoscopic hepatectomy (LH) is to control bleeding. The aims of this study were: (i) to assess the bleeding reduction effect by occlusion of the hepatic artery in LH; and (ii) to evaluate the risk of carbon dioxide (CO2 ) gas embolism (GE) in the case of high pneumoperitoneum (PP).
  
  
  METHODS
  Nine piglets underwent laparoscopic left medial lobe and left lateral lobe resection, receiving either occlusion of the hepatic artery (hepatic artery clamping group: HACG, n = 9) or no occlusion (hepatic artery declamping group: HADCG, n = 9) using a PP of 15 mmHg. In addition, we observed changes in hemodynamics induced by PP. The state of GE was observed using transesophageal echocardiography (TEE) during LH (n = 8). GE was graded as grade 0 (none), grade 1 (minor), and grade 2 (major).
  
  
  RESULTS
  The HACG had significantly less bleeding compared to the HADCG (P < 0.01). During LH, four animals showed grade 1 (37.5%) and one animal showed grade 2 (12.5%) GE at 15 mmHg. At 20 mmHg, all animals showed grade 2 (100%) GE.
  
  
  CONCLUSIONS
  The occlusion of the hepatic artery in LH reduces blood loss. The control of bleeding from the hepatic vein is feasible with a high PP, but there is a possibility of GE.
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Makabe
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nitta
authors.forename: Takeshi
authors.initials: T
authors.lastname: Takahara
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Shoji
authors.initials: S
authors.lastname: Kanno
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nishizuka
authors.forename: Akira
authors.initials: A
authors.lastname: Sasaki
authors.forename: Go
authors.initials: G
authors.lastname: Wakabayashi
mesh_terms: D000818:Animals; D002245:Carbon Dioxide / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D004618:Embolism, Air / Q000209:etiology* / Q000517:prevention & control; D006439:Hemodynamics; D006498:Hepatectomy; D006499:Hepatic Artery / Q000601:surgery*; D010535:Laparoscopy; D008026:Ligation; D008297:Male; D013552:Swine
chemical_list: D002245:Carbon Dioxide
keywords: Carbon dioxide gas embolism; Hemodynamics; Hepatic artery occlusion