Top

Surgical Endoscopy

Published in:

01-02-2007

Laparoscopic parenchymal division of the liver in a porcine model: comparison of the efficacy and safety of three different techniques

Authors: U. Jersenius, D. Fors, S. Rubertsson, D. Arvidsson

Published in: Surgical Endoscopy | Issue 2/2007

Abstract

Background

Bleeding is a known and CO₂ embolization a suggested risk factor for increased morbidity after laparoscopic liver resection. Devices for laparoscopic liver parenchymal transection must be evaluated for safety in this context.

Method

Twelve piglets underwent laparoscopic surgery during CO₂ pneumoperitoneum, each animal receiving three 6 cm long transections into the liver parenchyma made with ultrasonic dissector, ultrasonic shears and vessel sealing system, respectively. Endpoints were bleeding, operation time and gas embolization. The transections and embolization events, evaluated with transesophageal echocardiography, were video recorded. Bleeding and embolization were also assessed on video tapes and operating time measured. Arterial blood gases were recorded on line.

Results

The ultrasonic dissector was least advantageous in terms of bleeding and operation time. Gas embolization was more frequent with the vessel sealing system than with the ultrasonic dissector and ultrasonic shears. During two episodes of gas embolization, pCO₂ increased and pO₂ and pH decreased.

Conclusions

Use of all three devices is feasible. Bleeding and operation time are greatest with the ultrasonic dissector. Gas embolization occurs during transection, though in most instances it is completely harmless. Laparoscopic liver surgery with these techniques used may pose a risk of gas embolization with clinical implications. Monitoring for such events is probably to be recommended.

Lefor AT, Flowers JL (1994) Laparoscopic wedge biopsy of the liver. J Am Coll Surg 178: 307–308PubMed

Gagner MRM, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor (abstract). Surg Endosc 6: 99

Rogula T, Gagner M (2004) Current status of the laparoscopic approach to liver resection. J Long Term Eff Med Implants 14: 23–31CrossRef

Gigot JF, Glineur D, Santiago Azagra J, Goergen M, Ceuterick M, Morino M, Etienne J, Marescaux J, Mutter D, van Krunckelsven L, Descottes B, Valleix D, Lachachi F, Bertrand C, Mansvelt B, Hubens G, Saey JP, Schockmel R (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236: 90–97CrossRef

O’Rourke N, Fielding G (2004) Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg 8: 213–216CrossRef

Abouljoud M, Yoshida A, Dagher F, Moonka D, Brown K (2003) Living donor and split-liver transplantation: an overview. Transplant Proc 35: 2772–2774CrossRef

Cherqui D, Soubrane O, Husson E, Barshasz E, Vignaux O, Ghimouz M, Branchereau S, Chardot C, Gauthier F, Fagniez PL, Houssin D (2002) Laparoscopic living donor hepatectomy for liver transplantation in children. Lancet 359: 392–396CrossRef

Mala T, Edwin B, Gladhaug I, Fosse E, Soreide O, Bergan A, Mathisen O (2002) A comparative study of the short-term outcome following open and laparoscopic liver resection of colorectal metastases. Surg Endosc 16: 1059–1063CrossRef

Farges O, Jagot P, Kirstetter P, Marty J, Belghiti J (2002) Prospective assessment of the safety and benefit of laparoscopic liver resections. J Hepatobiliary Pancreat Surg 9: 242–248CrossRef

10.

Kaneko H, Takagi S, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, Maeda T, Shiba T (2005) Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 189: 190–194CrossRef

11.

Wei AC, Tung-Ping Poon R, Fan ST, Wong J (2003) Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma. Br J Surg 90: 33–41CrossRef

12.

Yamamoto J, Kosuge T, Takayama T, Shimada K, Yamasaki S, Ozaki H, Yamaguchi N, Mizuno S, Makuuchi M (1994) Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery 115: 303–309PubMed

13.

Stephenson KR, Steinberg SM, Hughes KS, Vetto JT, Sugarbaker PH, Chang AE (1988) Perioperative blood transfusions are associated with decreased time to recurrence and decreased survival after resection of colorectal liver metastases. Ann Surg 208: 679–687CrossRef

14.

Schmandra TC, Mierdl S, Bauer H, Gutt C, Hanisch E (2002) Transoesophageal echocardiography shows high risk of gas embolism during laparoscopic hepatic resection under carbon dioxide pneumoperitoneum. Br J Surg 89: 870–876CrossRef

15.

Strasberg SM, Drebin JA, Linehan D (2002) Use of a bipolar vessel-sealing device for parenchymal transection during liver surgery. J Gastrointest Surg 6: 569–574CrossRef

16.

Taniai N, Onda M, Tajiri T, Akimaru K, Yoshida H, Mamada Y (2002) Hepatic parenchymal resection using an ultrasonic surgical aspirator with electrosurgical coagulation. Hepatogastroenterology 49: 1649–1651PubMed

17.

Schmidbauer S, Hallfeldt KK, Sitzmann G, Kantelhardt T, Trupka A (2002) Experience with ultrasound scissors and blades (UltraCision) in open and laparoscopic liver resection. Ann Surg 235: 27–30CrossRef

18.

Romano F, Franciosi C, Caprotti R, Uggeri F (2005) Hepatic surgery using the Ligasure vessel sealing system. World J Surg 29: 110–112CrossRef

19.

Takagi S (1998) Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy. Surg Endosc 12: 427–431CrossRef

20.

Schmandra TC, Mierdl S, Hollander D, Hanisch E, Gutt C (2004) Risk of gas embolism in hand-assisted versus total laparoscopic hepatic resection. Surg Technol Int 12: 137–143PubMed

21.

Derouin M, Couture P, Boudreault D, Girard D, Gravel D (1996) Detection of gas embolism by transesophageal echocardiography during laparoscopic cholecystectomy. Anesth Analg 82: 119–124PubMed

22.

Cherqui D 2003 Laparoscopic liver resection. Br J Surg 90: 644–646CrossRef

23.

Buell JF, Thomas MJ, Doty TC, Gersin KS, Merchen TD, Gupta M, Rudich SM, Woodle ES (2004) An initial experience and evolution of laparoscopic hepatic resectional surgery. Surgery 136: 804–811CrossRef

24.

Jersenius U, Fors D, Rubertsson S, Arvidsson D (2006) The effects of experimental venous carbon dioxide embolization on hemodynamic and respiratory variables. Acta Anaesthesiol Scand 50(2): 156–162CrossRef

25.

Descottes B, Glineur D, Lachachi F, Valleix D, Paineau J, Hamy A, Morino M, Bismuth H, Castaing D, Savier E, Honore P, Detry O, Legrand M, Azagra JS, Goergen M, Ceuterick M, Marescaux J, Mutter D, de Hemptinne B, Troisi R, Weerts J, Dallemagne B, Jehaes C, Gelin M, Donckier V, Aerts R, Topal B, Bertrand C, Mansvelt B, Van Krunckelsven L, Herman D, Kint M, Totte E, Schockmel R, Gigot JF (2003) Laparoscopic liver resection of benign liver tumors. Surg Endosc 17: 23–30CrossRef

26.

Adam R, Pascal G, Azoulay D, Tanaka K, Castaing D, Bismuth H (2003) Liver resection for colorectal metastases: the third hepatectomy. Ann Surg 238: 871–883, discussion 883–874CrossRef

27.

Weber JC, Navarra G, Jiao LR, Nicholls JP, Jensen SL, Habib NA (2002) New technique for liver resection using heat coagulative necrosis. Ann Surg 236: 560–563CrossRef

28.

Haghighi KS, Steinke K, Hazratwala K, Kam PC, Daniel S, Morris DL (2005) Controlled study of in-line radiofrequency ablation (ILRFA) assisted transection of ovine liver. J Surg Res 123: 139–143CrossRef

29.

Haghighi KS, Wang F, King J, Daniel S, Morris DL (2005) In-line radiofrequency ablation to minimize blood loss in hepatic parenchymal transection. Am J Surg 190: 43–47CrossRef

30.

Spivak H, Richardson WS, Hunter JG (1998) The use of bipolar cautery, laparosonic coagulating shears, and vascular clips for hemostasis of small and medium-sized vessels. Surg Endosc 12: 183–185CrossRef

31.

Landman J, Kerbl K, Rehman J, Andreoni C, Humphrey PA, Collyer W, Olweny E, Sundaram C, Clayman RV (2003) Evaluation of a vessel sealing system, bipolar electrosurgery, harmonic scalpel, titanium clips, endoscopic gastrointestinal anastomosis vascular staples and sutures for arterial and venous ligation in a porcine model. J Urol 169: 697–700CrossRef

Title: Laparoscopic parenchymal division of the liver in a porcine model: comparison of the efficacy and safety of three different techniques
Authors: U. Jersenius
D. Fors
S. Rubertsson
D. Arvidsson
Publication date: 01-02-2007
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 2/2007
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-006-0758-0

At a glance: The STEP trials

Springer Medicine

Laparoscopic parenchymal division of the liver in a porcine model: comparison of the efficacy and safety of three different techniques

Abstract

Background

Method

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Method

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2007

Effects of prior endoluminal gastroplication on subsequent laparoscopic Nissen fundoplication

Impact of intraoperative ultrasonography in laparoscopic liver surgery

Open vs laparoscopic partial posterior fundoplication

Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review

Heating and humidifying carbon dioxide is indicated

Problems with technical equipment during laparoscopic surgery