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ABSTRACT: 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.
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.
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.
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.
Surgical Endoscopy 03/2007; 21(2):315-20. · 4.01 Impact Factor
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ABSTRACT: Laparoscopic liver resection is a relatively new surgical procedure. Carbon dioxide (CO2) pneumoperitoneum and laparoscopic liver dissection are recognized as risk factors for CO2 embolism to the pulmonary circulation. The embolization can be difficult to detect and can theoretically increase peri-operative morbidity. The aim of this study was to evaluate the cardiopulmonary effects in a pig model during a time period of 4 h after an experimental CO2 embolization.
Eleven piglets were anesthesized. Nine were embolized with a single intravenous injection of 0.4 ml/kg CO2 and two served as controls. Respiratory and cardiovascular variables, including pulmonary artery pressure and cardiac output, were monitored for 4 h after embolization, and arterial blood gases were monitored on-line.
The embolized piglets had an increase in ventilatory dead space, pulmonary vascular resistance and pulmonary artery pressure and a decrease in cardiac output that lasted throughout the 4-h observation time. The mean arterial pressure and heart rate were unchanged. An early sign of embolization was a rapid fall in end-tidal CO2 and P(a)O2 and a rise in P(a)CO2.
Negative changes in cardiopulmonary physiology persisted for at least 4 h after a single intravenous CO2 injection, in spite of this gas being highly soluble in blood. This is a more prolonged influence of CO2 embolization than previously described. Extensive monitoring for early detection of an embolization may be recommended to limit morbidity in patients undergoing laparoscopic liver surgery.
Acta Anaesthesiologica Scandinavica 03/2006; 50(2):156-62. · 2.19 Impact Factor
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ABSTRACT: One complication of radiofrequency ablation (RFA) of the liver is biliary duct damage. Intraductal cooling (IDC) has been proposed as a means of protection.
In the first experiment, designed to evaluate the influence of IDC on the RFA procedure per se and on lesion formation, lesions were created in vivo in pig liver with and without IDC. The RFA needle was placed with a 1.5-cm safety margin from the bile ducts. In the second experiment, designed to evaluate the potential protective effects of IDC, lesions were created close to a bile duct with and without IDC.
With the safety margin, the RFA parameters and lesion size were not negatively affected by IDC. Microscopic examination revealed that IDC had a protective effect in most of the lesions created close to a bile duct.
The IDC procedure was feasible and had no negative effect on the RFA procedure or the lesions. However, the protective effect of IDC was not statistically significant (p = 0.12).
Surgical Endoscopy 05/2005; 19(4):546-50. · 4.01 Impact Factor
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ABSTRACT: Liver surgery is developing with new techniques and treatment modalities. The aim of this study is to describe liver surgery over a long period of time in a country with a public health care system.
A register study including adult patients admitted for liver resection in Sweden (population 8.8 million) selected from the Inpatient Register 1987-99. Additional data were collected from the Swedish Cancer Register and the Cause of Death Register. Analyses of the patients, indications, mortality and causes of death are presented.
2,405 operations were performed (21 per million per year). The most frequent indication was colorectal metastases (27%). The 5-year survival after an operation for primary liver cancer and colorectal liver metastases was 27% and 26%, respectively.
Few patients were admitted for liver operations compared to expected figures. The survival rates are in conformity with those previously published. With an increasing awareness of the relatively favourable prognosis and the introduction of new methods, the volume of liver operations will probably increase in Sweden.
Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 02/2005; 94(1):25-30. · 1.03 Impact Factor
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Lakartidningen 12/1994; 91(44):3981-2, 3985-6.
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ABSTRACT: From January 1985 to September 1993, 399 patients (368 men and 31 women), median age 28 years (mean 31.1, range 16-71 years), were admitted with stab wounds due to assault. The number of stab wounds per patient was one (N = 268 patients), two (N = 63), three (N = 31), four (N = 15), five (N = 7), or more than five (N = 15). The series as whole (N = 399) accounted for 543 sites of injury. Upper extremity wounds were the most frequent (35 per cent); of 188 arm injuries, 60 per cent were in the left arm. The next most frequent site was the head and neck region (N = 105; 12 per cent), followed by the chest (N = 75; 14 per cent), abdomen (N = 66;12 per cent), lower extremities (N = 59;11 per cent), back (N = 48;9 per cent), and the male genitalia (N = 2;0.4 per cent). Ninety-five major operations were performed in 74 patients. Seven patients died, and 40 had somatic or cosmetic life-time sequelae.
Lakartidningen 11/1994; 91(42):3801-4.
