Incidence and Risk Factors of Symptomatic Venous Gas Embolism During Laparoscopic Liver Resection

Risk factors of symptomatic venous gas embolism (GE) during laparoscopic liver resection (LLR) are poorly known. The objective of this study was to report the incidence, risk factors, and morbidity of symptomatic GE during LLR.

All consecutive patients who underwent LLR in 3 French centers over 3 years were retrospectively studied. All intraoperative events, with a focus on symptomatic venous GE, were collected and reviewed.

Among the 518 LLR (507 patients) studied, 26 (5%) cases of symptomatic GE occurred. There was no GE-related death nor neurological sequelae after GE. The group of patients with GE and without GE was similar in terms of baseline characteristics, type of resection, and pneumoperitoneum pressure (≤ 12 mmHg in 93% of LLR) or intraoperative bleeding. Overall morbidity and length of stay were longer after GE. The probability of GE was higher under the Airseal insufflation system at 12 mmHg (7.1% with Airseal versus 0.59% with conventional systems, odds ratio 12.73, 95% confidence interval [2.66-228.4], p = 0.013).

Our results suggest that AirSeal at 12 mmHg or more is a risk factor for symptomatic venous GE. Insufflation with lower pressure or alternative insufflation systems should be evaluated during LLR.