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Effects of Prolonged Pneumoperitoneum on Hepatic Perfusion During Laparoscopy

Hoekstra, Lisette T. MD*; Ruys, Anthony T. MD*; Milstein, Dan M. J. MD, PhD; van Samkar, Gan MD; van Berge Henegouwen, Mark I. MD, PhD*; Heger, Michal PhD*; Verheij, Joanne MD, PhD§; van Gulik, Thomas M. MD, PhD*

doi: 10.1097/SLA.0b013e31825d5b2b
Original Articles

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 intra-abdominal pressure, which potentially influences hepatic function and microcirculatory perfusion.

Methods: Six pigs (49.6 ± 5.8 kg) underwent laparoscopic intra-abdominal insufflation with 14 mm Hg CO2 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 flow and function were 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: A decrease in microvascular perfusion was 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.

Pneumoperitoneum (PP) during laparoscopy produces elevated intra-abdominal pressure with compression of intra-abdominal organs. This becomes more relevant when the liver may be subjected to additional injury when applying vascular inflow occlusion. The influence of prolonged PP on liver function and perfusion is investigated in a porcine model of extended laparoscopy.

Departments of *Surgery (Surgical Laboratory)

Translational Physiology

Anaesthesiology

§Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Reprints: Thomas M. van Gulik, MD, PhD, Department of Surgery (Surgical Laboratory), Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail: t.m.vangulik@amc.uva.nl.

Disclosure: The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.