Document Detail


Laparoscopic parenchymal division of the liver in a porcine model: comparison of the efficacy and safety of three different techniques.
MedLine Citation:
PMID:  17219291     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
U Jersenius; D Fors; S Rubertsson; D Arvidsson
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2007-01-06
Journal Detail:
Title:  Surgical endoscopy     Volume:  21     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-01-12     Completed Date:  2007-02-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  315-20     Citation Subset:  IM    
Affiliation:
Section of Surgery, Department of Molecular Medicine and Surgery, Karolinska University Hospital Huddinge, Karolinska Institute, SE-171 76, Stockholm, Sweden. ulf.jersenius@karolinska.se
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Animals
Blood Gas Analysis
Blood Loss, Surgical / prevention & control*
Disease Models, Animal
Echocardiography, Transesophageal
Embolism, Air / prevention & control*
Equipment Safety
Female
Hemostasis, Surgical / instrumentation,  methods
Hepatectomy / adverse effects,  methods*
Laparoscopes
Laparoscopy / adverse effects,  methods*
Liver / pathology*,  ultrasonography
Male
Pneumoperitoneum, Artificial / adverse effects,  methods
Probability
Sensitivity and Specificity
Swine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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