Article

Surgical Endoscopy

, Volume 15, Issue 7, pp 729-733

First online:

Elevated intrahepatic pressures and decreased hepatic tissue blood flow prevent gas embolus during limited laparoscopic liver resections

  • R. RicciardiAffiliated withDepartment of Surgery, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA
  • , S. AnwaruddinAffiliated withDepartment of Surgery, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA
  • , B.K. SchafferAffiliated withDepartment of Surgery, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA
  • , S.H. QuarfordtAffiliated withDepartment of Surgery, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA
  • , S.E. DonohueAffiliated withDepartment of Surgery, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA
  • , S.M. WheelerAffiliated withDepartment of Surgery, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA
  • , K.A. GallagherAffiliated withDepartment of Surgery, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA
  • , M.P. CalleryAffiliated withDepartment of Surgery, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA
  • , D.E.M. LitwinAffiliated withDepartment of Surgery, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA
    • , W.C. MeyersAffiliated withDepartment of Surgery, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA

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Abstract

Background: As new techniques are emerging for laparoscopic liver resections, concerns have been raised about the development of gas embolus related to the CO2 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 CO2 pneumoperitoneum. Gas embolus was determined after hepatic incision by monitoring pulmonary arterial pressure (PAP), hepatic venous PCO2, 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 PCO2 (p = NS). Conclusion: These data suggest that the risk of significant embolus under conventional pneumoperitoneum is minimal during laparoscopic liver resections.