Gas embolisation in laparoscopic liver surgery

Principal investigator: Sten Rubertsson

Background: Laparoscopic surgery has in general been known because of several advantages for the patient compared to open surgery such as less pain, shorter hospital stay and shorter periods of sick leave. The technique has developed from initial use for an increasing number of surgical procedures in the abdomen and pelvic region. To improve the view and the availability for the surgeon CO2 is inflated into the abdomen in the beginning of the procedure. A rare but feared complication due to this inflated gas is the risk for venous CO2–embolisation where even fatal cases have been reported in liver surgery. There are reasons to suspect that CO2–embolisation could be the reason due to the liver structure with many large low pressure veins that could remain open after the incision into the hepatic parenchyma. Different methods to detect embolisation have been used, such as measurements of en-tidal CO2, mean pulmonary arterial pressure, the use of transesofageal echocardiography or auscultation.

Questions: Can different interventions of the anaesthesiologist or surgeon have an impact of the risk for embolisation? How can we detect gas embolisation with the monitoring techniques used today? Will the surgical technique influence bleeding and gas embolisation during laparoscopic liver resection?

Methods and results: Experimental studies are performed in anesthetized pigs instrumented with catheters for measurements of hemodynamic and respiratory parameters, on-line arterial blood gas analysis and blood sampling. To detect venous embolisation, transesofageal echocardiography will be used to visualize the rights side of the heart. Four studies have already been performed where a certain amount of CO2 has been injected into the blood circulation to detect and follow changes in hemodynamic and respiratory variables during the following four hours. We have developed a method to quantify the degree of embolisation with transesofageal echocardiography. We have also shown that early detection of gas embolisation can be done with on-line measurements of arterial blood gases.

Members of the group during 2013
Sten Rubertsson, Professor
Dag Arvidsson, Associate Professor, MD, PhD
Diddi Fors, MD, PhD student
Kristin Eiriksson, PhD student

Last modified: 2021-04-15