Gas embolism in laparoscopic hepatectomy: what is the optimal pneumoperitoneal pressure for laparoscopic major hepatectomy?

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 20; no. 2; pp. 137 - 140
• Main Authors: Otsuka, Yuichiro, Katagiri, Toshio, Ishii, Jun, Maeda, Tetsuya, Kubota, Yoshihisa, Tamura, Akira, Tsuchiya, Masaru, Kaneko, Hironori
• Format: Journal Article
• Language: English
• Published: Japan Blackwell Publishing Ltd 01.02.2013; Springer Japan; Wiley Subscription Services, Inc
• Subjects: Abdominal Surgery; Animals; Embolism, Air - epidemiology; Embolism, Air - etiology; Embolism, Air - prevention & control; Embolisms; gas embolism; Gastroenterology; Global Health; Hepatectomy - adverse effects; Hepatectomy - methods; Hepatology; Humans; Incidence; Insufflation - standards; Intraoperative Complications - epidemiology; Intraoperative Complications - etiology; Intraoperative Complications - prevention & control; laparoscopic hepatectomy; laparoscopic liver resection; Laparoscopy; Laparoscopy - adverse effects; Liver Diseases - surgery; major hepatectomy; Medicine; Medicine & Public Health; Peritoneal Cavity - physiopathology; pneumoperitoneum; Pneumoperitoneum, Artificial - standards; Pressure; Risk Factors; Surgical Oncology; Topics; Laparoscopic liver resection; Laparoscopic hepatectomy; Gas embolism; Pneumoperitoneum; Major hepatectomy
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1007/s00534-012-0556-0

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.