Treatment of hepatic venous system hemorrhage and carbon dioxide gas embolization during laparoscopic hepatectomy via hepatic vein approach

Abstract

With the improvement of laparoscopic surgery, the feasibility and safety of laparoscopic hepatectomy have been affirmed, but intraoperative hepatic venous system hemorrhage and carbon dioxide gas embolism are the difficulties in laparoscopic hepatectomy. The incidence of preoperative hemorrhage and carbon dioxide gas embolism could be reduced through preoperative imaging evaluation, reasonable liver blood flow blocking method, appropriate liver-breaking device, controlled low-center venous pressure technology, and fine-precision precision operation. In the case of blood vessel rupture bleeding in the liver vein system, after controlling and reducing bleeding, confirm the type and severity of vascular damage in the liver and venous system, take appropriate measures to stop the bleeding quickly and effectively, and, if necessary, transfer the abdominal treatment in time. In addition, to strengthen the understanding, prevention and emergency treatment of severe CO2 gas embolism in laparoscopic hepatectomy is also the key to the success of surgery. This study aims to investigate the methods to deal with hepatic venous system hemorrhage and carbon dioxide gas embolization based on author's institutional experience and relevant literature. We retrospectively analyzed the data of 60 patients who received laparoscopic anatomical hepatectomy of hepatic vein approach for HCC. For patients with intraoperative complications, corresponding treatments were given to cope with different complications. After the operation, combined with clinical experience and literature, we summarized and discussed the good treatment methods in the face of such situations so that minimize the harm to patients as much as possible.

Keywords: gas embolism; hemorrhage; hepatectomy; hepatic vein; laparoscopy.

Figure 1

Port sites.

Figure 2

(A) By intraoperative ultrasound to localize liver tumors. (B) Transection of liver tissue with ultrasonic scalpel. (C) Used 5-0 prolene to suture laceration of retrohepatic inferior vena cava(RIVC) under laparoscope. (D) Laparoscopic separation of the VIII.

Figure 3

(A) Resection of the segment VIII, the right hepatic vein (RHV) and middle hepatic vein (MHV) were exposed during the operation. (B) After right lobe hepatectomy, the inferior vena cava (IVC) and middle hepatic vein (MHV) were exposed.