Low Pneumoperitoneum Pressure Reduces Gas Embolism During Laparoscopic Liver Resection: A Randomized Controlled Trial

Area of Science:

• Minimally Invasive Surgery
• Surgical Safety
• Hepatobiliary Surgery

Background:

• Laparoscopic liver resection (LLR) carries an elevated risk of gas embolism.
• Animal studies suggest low pneumoperitoneal pressure (PP) may mitigate gas embolism, but clinical data is limited.

Purpose of the Study:

• To compare the incidence of severe gas embolism between low (10 mm Hg) and standard (15 mm Hg) PP during LLR.
• To evaluate intraoperative hemodynamics and postoperative recovery in relation to PP levels.

Main Methods:

• A parallel, dual-arm, double-blind, randomized controlled trial involving 141 patients undergoing elective LLR.
• Patients were randomized to standard (15 mm Hg) or low (10 mm Hg) PP groups.
• Severe gas embolism was detected via transesophageal echocardiography using the Schmandra microbubble method.

Main Results:

• The low PP group showed significantly fewer cases of severe gas embolism (40.8% vs 67.1%, P = 0.003).
• Reduced duration of severe gas embolism, fewer vital sign derangements (e.g., decreased end-tidal CO2, reduced SpO2, increased heart rate/lactate) were observed in the low PP group.
• The low PP group required less fluid and vasoactive drug administration, with comparable postoperative recovery.

Conclusions:

• Low PP effectively reduces the incidence and duration of severe gas embolism during LLR.
• A low PP strategy promotes steadier hemodynamics and vital signs, enhancing surgical safety.
• Low PP is a valuable and recommended strategy for future laparoscopic liver resections.