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Endovascular isolated hepatic perfusion under pneumoperitoneum
D Christoforidis1, C Antonescu, J Horisberger
1Department of General Surgery, University Hospital of Lausanne, CHUV, 1011 Lausanne, Switzerland. dchristo@hospvd.ch
Summary
Pneumoperitoneum (PP) during isolated hepatic perfusion (IHP) is feasible but does not reduce systemic leakage. High pressure gradients during PP increase leakage, which resolves upon its release.
Area of Science:
- Hepatic oncology
- Surgical innovation
- Vascular access
Background:
- Isolated hepatic perfusion (IHP) enables loco-regional chemotherapy delivery for liver cancer.
- Minimally invasive endovascular techniques for IHP face challenges with controlling drug leakage.
- CO(2)-pneumoperitoneum (PP) was investigated for its potential to reduce leakage via mechanical compression.
Purpose of the Study:
- To evaluate the efficacy of CO(2)-pneumoperitoneum (PP) in reducing systemic leakage during isolated hepatic perfusion (IHP).
- To assess the impact of PP on leakage rates and hemodynamic parameters during IHP in a porcine model.
Main Methods:
- IHP was performed on pigs using a double balloon-catheter in the vena cava and extracorporeal circulation.
- Leakage rates were monitored using nuclear medicine during four phases: open abdomen, 15 mmHg PP, 20 mmHg PP, and abdomen re-opened.
- Systemic arterial pressure, IHP pressures, and flow rates were recorded.
Main Results:
- Systemic leakage occurred in all animals with an open abdomen.
- Under PP, leakage profiles varied: increased leakage with high pressure gradients (>50 mmHg), and no change or decreased leakage with low gradients (<30 mmHg).
- Leakage was undetectable after PP was released.
Conclusions:
- Isolated hepatic perfusion under pneumoperitoneum is technically feasible.
- Pneumoperitoneum did not consistently reduce systemic leakage during IHP.
- High pressure gradients between IHP inflow and systemic circulation exacerbated leakage during PP.