• Kenji Makabe, Hiroyuki Nitta, Takeshi Takahara, Yasushi Hasegawa, Shoji Kanno, Satoshi Nishizuka, Akira Sasaki, and Go Wakabayashi.
• Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
• J Hepatobiliary Pancreat Sci. 2014 Aug 1; 21 (8): 592-8.

BackgroundThe important point in safely performing laparoscopic hepatectomy (LH) is to control bleeding. The aims of this study were: (i) to assess the bleeding reduction effect by occlusion of the hepatic artery in LH; and (ii) to evaluate the risk of carbon dioxide (CO2 ) gas embolism (GE) in the case of high pneumoperitoneum (PP).MethodsNine piglets underwent laparoscopic left medial lobe and left lateral lobe resection, receiving either occlusion of the hepatic artery (hepatic artery clamping group: HACG, n = 9) or no occlusion (hepatic artery declamping group: HADCG, n = 9) using a PP of 15 mmHg. In addition, we observed changes in hemodynamics induced by PP. The state of GE was observed using transesophageal echocardiography (TEE) during LH (n = 8). GE was graded as grade 0 (none), grade 1 (minor), and grade 2 (major).ResultsThe HACG had significantly less bleeding compared to the HADCG (P < 0.01). During LH, four animals showed grade 1 (37.5%) and one animal showed grade 2 (12.5%) GE at 15 mmHg. At 20 mmHg, all animals showed grade 2 (100%) GE.ConclusionThe occlusion of the hepatic artery in LH reduces blood loss. The control of bleeding from the hepatic vein is feasible with a high PP, but there is a possibility of GE.© 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

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