G. van Samkar
M.I. van Berge Henegouwen
T.M. van Gulik
- Effects of prolonged pneumoperitoneum on hepatic perfusion during laparoscopy
- Annals of Surgery
- Volume | Issue number
- 257 | 2
- Pages (from-to)
- Document type
- Faculty of Dentistry (ACTA)
Objective: To assess the influence of prolonged pneumoperitoneum (PP) on liver function and perfusion in a clinically relevant porcine model of laparoscopic abdominal insufflation.
Background: PP during laparoscopic surgery produces increased intraabdominal pressure, which potentially influences hepatic function and microcirculatory perfusion.
Methods: Six pigs (49.6 ± 5.8 kg) underwent laparoscopic intra-abdominal insufflationwith 14mmHgCO2 gas for 6 hours, followed by a recovery period of 6 hours. Two animals were subjected to 25 mm Hg CO2 gas. Hemodynamic parameters were monitored, and damage parameters in the blood were measured to assess liver injury. Liver total blood flowand functionwere determined
by the indocyanine green (ICG) clearance test. Intraoperative hepatic hemodynamics were measured by simultaneous reflectance spectrophotometry (venous oxygen saturation StO2 and relative tissue hemoglobin concentration rHb) and laser Doppler flowmetry (blood flow and flow velocity). Postmortem liver samples were collected for histological evaluation.
Results: Adecrease inmicrovascular perfusionwas observed during PP. After 6 hours of PP, ICG clearance increased (P<0.001), indicating a compensatory improvement of overall liver blood flow resulting in concomitantly improved microcirculatory perfusion (P = 0.024). Minimal parenchymal damage (aspartate aminotransferase) of the liver was seen after 6 hours of PP (P = 0.006), which seemed related to PP pressure. Minor histological damage was observed.
Conclusions: The liver sustains no additional damage due to prolonged PP during laparoscopic surgery. Our findings suggest that prolonged PP does not hamper liver function or cause liver damage after extended laparoscopic procedures.
- go to publisher's site
If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library, or send a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible.