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Microcirculation and excretory function of the liver under conditions of carbon dioxide pneumoperitoneum

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Abstract

Background: To date, the effects of increased abdominal pressure, as given during carbon dioxide (CO2) pneumoperitoneum, on hepatic microcirculation and biliary excretion are unknown.

Methods: Using a custom-made peritoneal cavity chamber, we performed intravital microscopy of the left liver lobe under conditions of CO2 pneumoperitoneum in a rat model. In addition, biliary excretion was assessed.

Results: The establishment of a CO2 pneumoperitoneum of 4 or 8 mmHg resulted in sinusoidal perfusion failure that was more pronounced in the periportal regions than in the midzonal and pericentral regions of the liver acinus. Biliary excretion was considerably reduced at an intraabdominal pressure of 8 mmHg. Leukocyte–endothelial cell interactions increased significantly in both hepatic sinusoids and postsinusoidal venules.

Conclusion: Alterations in hepatic microcirculation and liver function must be taken into consideration in any kind of laparoscopic surgery and may be of particular clinical relevance in patients with liver pathology.

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Authors and Affiliations

  1. Department of General Surgery, Georg August University, Robert Kochstrasse 40, D-37075, Göttingen, Germany

    I. Leister, P. Schüler, H. Becker & P. M. Markus

  2. Department of Experimental Surgery, University of Rostock, Schillingallee 70, D-18055, Rostock, Germany

    B. Vollmar

  3. Department of Pathology, Georg August University, Robert Kochstrasse 40, D-37075, Göttingen, Germany

    L. Füzesi

  4. Department of Medical Statistics, Georg August University, Humboldtallee 32, D-37075, Göttingen, Germany

    E. Kahler

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  1. I. Leister
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  2. P. Schüler
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  3. B. Vollmar
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  7. P. M. Markus
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Correspondence to I. Leister.

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Leister, I., Schüler, P., Vollmar, B. et al. Microcirculation and excretory function of the liver under conditions of carbon dioxide pneumoperitoneum. Surg Endosc 18, 1358–1363 (2004). https://doi.org/10.1007/s00464-003-9252-0

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  • DOI: https://doi.org/10.1007/s00464-003-9252-0

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