Efficacy of occlusion of hepatic artery and risk of carbon dioxide gas embolism during laparoscopic hepatectomy in a pig model. (21st April 2014)

• Record Type: Journal Article
• Authors: Makabe, Kenji; Nitta, Hiroyuki; Takahara, Takeshi; Hasegawa, Yasushi; Kanno, Shoji; Nishizuka, Satoshi; Sasaki, Akira; Wakabayashi, Go
• Is Part Of: Journal of hepato-biliary-pancreatic sciences. Volume 21:Number 8(2014)
• Page Start: 592
• Page End: 598
• Publication Date: 2014-04-21
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 617.556
• DOI: 10.1002/jhbp.103
• Languages: English
• ISSNs: 1868-6974

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="jhbp103-sec-0001" sec-type="section"> <title>Background</title> <p>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 (CO<sub>2</sub>) gas embolism (GE) in the case of high pneumoperitoneum (PP).</p> </sec> <sec id="jhbp103-sec-0002" sec-type="section"> <title>Methods</title> <p>Nine piglets underwent laparoscopic left medial lobe and left lateral lobe resection, receiving either occlusion of the hepatic artery (hepatic artery clamping group: HACG, <italic>n</italic> = 9) or no occlusion (hepatic artery declamping group: HADCG, <italic>n</italic> = 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 (<italic>n</italic> = 8). GE was graded as grade 0 (none), grade 1 (minor), and grade 2 (major).</p> </sec> <sec id="jhbp103-sec-0003" sec-type="section"> <title>Results</title> <p>The HACG had significantly less bleeding compared to the HADCG (<italic>P</italic> < 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.</p> </sec> <sec id="jhbp103-sec-0004" sec-type="section"> <title>Conclusion</title> <p>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.</p> </sec> </abstract>