Transoesophageal echocardiography shows high risk of gas embolism during laparoscopic hepatic resection under carbon dioxide pneumoperitoneum

Abstract

The UAS causes minimal blood loss during both open and laparoscopic hepatic resection. Laparoscopic liver dissection under carbon dioxide pneumoperitoneum carries a high risk of gas embolism.

Bleeding and hemostasis in laparoscopic liver surgery

“…Previous experience with open liver surgery has shown that lowering the CVP to between 0-and 5-cm H 2 O through a combination of fluid limitation, patient position, and anesthetic techniques reduces operative blood loss and the need for transfusion [12]. However, laparoscopic liver surgery carries a higher risk of venous gas embolism [10], and we have found that a slightly higher CVP is needed.…”

“…Bleeding can obscure views, making surgery difficult, and the loss of manual compression can make surgery harder to control, occasionally necessitating conversion to open procedure [9]. In addition, major bleeding from hepatic veins can be associated with gas embolism, especially in a high intraabdominal pressure setting [10][11][12], and any blood loss necessitating transfusion increases the risk of postoperative morbidity, mortality [13][14][15], and tumor recurrence [16,17]. Therefore, familiarity with the various hemostatic methods, techniques, and tools is an essential requirement for all laparoscopic surgeons, and their continuing development is important for the safe expansion of this surgical approach.…”

Stand der laparoskopischen Leberchirurgie

“…Mögli-cherweise führt der intraabdominelle Druck zu einem Kollaps der verletzten Vene durch Druck von Außen und verhindert dadurch die Luftembolie. Pathophysiologische Untersuchungen zeigen jedoch, dass im Tiermodell Luftembolien mittels transösophagealer Ultraschalluntersuchung regelhaft detektiert werden können [48]. Der Gefahr einer Gasembolie durch das Pneumoperitoneum kann mit entsprechenden Bauchdeckenhalterungen ohne der Notwendigkeit eines Pneumoperitoneums begegnet werden.…”

Renal Cell Carcinoma in Dialysis Patients with End Stage Renal Disease: Focus on Surgery and Pathology

“…Its clinical presentation ranges from asymptomatic to neurogenic injury, cardiovascular collapse or even death depending on the rate and volume of gas entrapment and patient condition. Venous CO 2 embolism of laparoscopy occurs in 15 per 100,000 cases per year 39,40 . Incidences of subclinical embolism during various laparoscopic procedures have been reported to occur in as much as 6% of nephrectomy cases 41 and 17.1% total prostatectomy cases 42 when transesophageal echocardiography (TEE) was used for monitoring.…”