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Carbon dioxide pneumoperitoneum-related liver injury is pressure dependent: A study in an isolated-perfused organ model

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Abstract

Background

Disturbed liver function tests are associated with the pneumoperitoneum applied for biliary and non-biliary laparoscopic surgical procedures. The extent, duration and reversibility of such an injury are unknown. An isolated organ model was used to assess reversibility of liver injury in a CO2–pneumoperitoneum-like environment.

Methods

Rat livers (n = 63) were isolated and perfused within a chamber pressurized at 0, 3, 5, 8, 12, 15 or 18 mmHg for 60 minutes. Pressure was annulled during the ensuing 61–90 minutes in one-half of the groups and markers of liver function were measured and recorded.

Results

Inflow pressure level, flow rate, effluent partial O2 and CO2 pressures, O2 extraction rate, lactate dehydrogenase level, lactic to pyruvic acid ratio, and total xanthine oxidase and dehydrogenase levels became abnormal, starting at 15 minutes after a pressure >5 mmHg was applied in the chamber. Signs of injury slowly reversed towards baseline values in all groups except for the 15 mmHg and 18 mmHg-pressurized ones, even after pressure had been annulled for 30 minutes.

Conclusions

CO2-pneumoperitoneum-like conditions directly injured rat liver tissue to a degree which correlated with the amount of applied pressure. Damage caused by pressure ≥15 mmHg was no longer reversible if it had been applied over a 60-minute period.

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References

  1. Andrei VE, Schein M, Margolis M, Rucinski JC, Wise L (1998) Liver enzymes are commonly elevated following laparoscopic cholecystectomy: is elevated intra-abdominal pressure the cause? Dig Surg 15:256–259

    Article  CAS  PubMed  Google Scholar 

  2. Baqi N, Stock J, Lombardo SA, Geffner S, Roberti I (2006) Impact of laparoscopic donor nephrectomy on allograft function in pediatric renal transplant recipients: a single-center report. Pediatr Transplant 10:354–357

    Article  PubMed  Google Scholar 

  3. Bendet N, Morozov V, Lavi R, Panski M, Halevy A, Scapa E (1999) Does laparoscopic cholecystectomy influence peri-sinusoidal cell activity? Hepatogastroenterology 46:1603–1606

    CAS  PubMed  Google Scholar 

  4. Clary EM, Bruch SM, Lau CL, Ali A, Chekan EG, Garcia-Oria MJ, Eubanks S (2002) Effects of pneumoperitoneum on hemodynamic and systemic immunologic responses to peritonitis in pigs. J Surg Res 108:32–38

    Article  CAS  PubMed  Google Scholar 

  5. Giraudo G, Brachet Contul R, Caccetta M, Morino M (2001) Gasless laparoscopy could avoid alterations in hepatic function. Surg Endosc 15:741–746

    Article  CAS  PubMed  Google Scholar 

  6. Gisek LG, Gobet RM, Peters CA (1998) Pneumoperitoneum produces reversible renal dysfunction in animals with normal and chronically reduced renal function. J Endourol 12:95–100

    Article  Google Scholar 

  7. Gutt CN, Schmandra TC (1999) Portal venous flow during CO2 pneumoperitoneum in the rat. Surg Endosc 13:902–905

    Article  CAS  PubMed  Google Scholar 

  8. Halevy A, Gold-Deutch R, Negri M, Lin G, Shlamkovich N, Evans S, Cotariu D, Scapa E, Bahar M, Sackier JM (1994) Are elevated liver enzymes and bilirubin levels significant after laparoscopic cholecystectomy in the absence of bile duct injury? Ann Surg 219:362–36413

    Article  CAS  PubMed  Google Scholar 

  9. Hashimoto S (1974) A new spectrophotometric assay method of xanthine oxidase in crude tissue homogenate. Anal Biochem 62:426–435

    Article  CAS  PubMed  Google Scholar 

  10. Ho HS, Saunders CJ, Gunther RA, Wolfe BM (1995) Effector of hemodynamics during laparoscopy: CO2 absorption or intraabdominal pressure? J Surg Res 59:497–503

    Article  CAS  PubMed  Google Scholar 

  11. Jakimowicz J, Stultiens G, Smulders F (1998) Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc 12:129–132

    Article  CAS  PubMed  Google Scholar 

  12. Kim ZG, Sanli E, Brinkmann L, Lorenz M, Gutt CN (2002) Impact of dopamine and endothelin-1 antagonism on portal venous blood flow during laparoscopic surgery. Surg Endosc 16:1292–1296

    Article  PubMed  Google Scholar 

  13. Kotake Y, Takeda J, Matsumoto M, Tagawa M, Kikuchi H (2001) Subclinical hepatic dysfunction in laparoscopic cholecystectomy and laparoscopic colectomy. Br J Anaesth 87:774–777

    Article  CAS  PubMed  Google Scholar 

  14. Morino M, Giraudo G, Festa V (1998) Alterations in hepatic function during laparoscopic surgery. An experimental clinical study. Surg Endosc 12:968–972

    Article  CAS  PubMed  Google Scholar 

  15. Nakache R, Rudick V, Fiodorov D, Klausner JM, Almogy N, Karckevski E, Weinbroum AA (1999) Cumulative damaging effect of liver hypoperfusion and cyclosporine a on the peribiliary capillary plexus: a study in an isolated dually perfused rat model. Transplantation 68:1651–1660

    Article  CAS  PubMed  Google Scholar 

  16. Richter S, Olinger A, Hildebrandt U, Menger MD, Vollmar B (2001) Loss of physiologic hepatic blood flow control (“hepatic arterial buffer response”) during CO2-pneumoperitoneum in the rat. Anesth Analg 93:872–877

    Article  CAS  PubMed  Google Scholar 

  17. Sato K, Kawamura T, Wakusawa R (2000) Hepatic blood flow and function in elderly patients undergoing laparoscopic cholecystectomy. Anesth Analg 90:1198–1202

    Article  CAS  PubMed  Google Scholar 

  18. Schmandra TC, Kim ZG, Gutt CN (2001) Effect of insufflation gas and intraabdominal pressure on portal venous flow during pneumoperitoneum in the rat. Surg Endosc 15:405–408

    Article  CAS  PubMed  Google Scholar 

  19. Tunon MJ, Gonzalez P, Jorquera F, Llorente A, Gonzalo-Orden M, Gonzalez-Gallego J (1999) Liver blood flow changes during laparoscopic surgery in pigs. A study of hepatic indocyanine green removal. Surg Endosc 13:668–672

    Article  CAS  PubMed  Google Scholar 

  20. Waldschmidt J, Haring R, Hauck W, Perez Rde P, Tung LC (1970) Experimental studies on the effect of diaphragm movement and intra-abdominal pressure on liver circulation. Thoraxchir Vask Chir 18:114–121

    CAS  PubMed  Google Scholar 

  21. Weinbroum A, Nielsen VG, Tan S, Gelman S, Matalon S, Skinner KA, Bradley E Jr., Parks DA (1995) Liver ischemia-reperfusion increases pulmonary permeability in rat: role of circulating xanthine oxidase. Am J Physiol 268:G988–G996

    CAS  PubMed  Google Scholar 

  22. Weinbroum AA, Hochhauser E, Rudick V, Kluger Y, Karchevsky E, Graf E, Vidne BA (1999) Multiple organ dysfunction following remote circulatory arrest: common pathway of radical oxygen species? J Trauma 47:691–698

    Article  CAS  PubMed  Google Scholar 

  23. Weinbroum AA, Kluger Y, Abraham RB, Shapira I, Karchevski E, Rudick V (2001) Lung preconditioning with N-acetyl-L-cysteine prevents reperfusion injury after liver no flow-reflow: a dose-response study. Transplantation 71:300–306

    Article  CAS  PubMed  Google Scholar 

  24. Yokoyama Y, Beckman JS, Beckman TK, Wheat JK, Cash TG, Freeman BA, Parks DA (1990) Circulating xanthine oxidase: potential mediator of ischemic injury. Am J Physiol 258:G564–G570

    CAS  PubMed  Google Scholar 

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Acknowledgments

Esther Eshkol is thanked for editorial assistance.

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Authors and Affiliations

  1. Endoscopic Surgery Service, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Amir Szold

  2. Post-Anesthesia Care Unit and Animal Research Laboratory, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Avi A. Weinbroum

Authors
  1. Amir Szold
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  2. Avi A. Weinbroum
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Correspondence to Avi A. Weinbroum.

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Szold, A., Weinbroum, A.A. Carbon dioxide pneumoperitoneum-related liver injury is pressure dependent: A study in an isolated-perfused organ model. Surg Endosc 22, 365–371 (2008). https://doi.org/10.1007/s00464-007-9411-9

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  • DOI: https://doi.org/10.1007/s00464-007-9411-9

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