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

Background: As new techniques are emerging for laparoscopic liver resection s, concerns have been raised about the development of gas embolus related t o the CO2 pneumoperitoneum. We hypothesized that elevated intrahepatic vasc ular pressures and decreased hepatic tissue blood flow (LQ(B)) would preven t gas embolus during laparoscopic liver resections under conventional pneum operitoneum. Methods: Intrahepatic vascular pressures and LQ(B) were measured in nine pi gs with varying CO2 pneumoperitoneum. Gas embolus was determined after hepa tic incision by monitoring pulmonary arterial pressure (PAP), hepatic venou s P-CO2, systemic blood pressure (SBP), and suprahepatic vena cava ultrasou nd. Results: As the pneumoperitoneum was increased from 0 to 15 mmHg, intrahepa tic vascular pressures increased significantly 0, < 0.05), while LQ, decrea sed significantly (p < 0.05). A 2.0-cm hepatic incision at 4, 8, 15, and 20 mmHg produced no ultrasound evidence of gas embolus and no changes in PAP, SEP, or hepatic venous P-CO2 (p = NS). Conclusion: These data suggest that the risk of significant embolus under c onventional pneumoperitoneum is minimal during laparoscopic liver resection s.