Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (all authors).

ABSTRACT

Although rare, complications can arise during the establishment of pneumoperitoneum during laparoscopic surgery. These include injury to blood vessels, hollow viscera, solid organs, and CO2 embolism.

We report a case of trauma to the liver following the insertion of a Veress needle causing CO2 embolism during laparoscopic adrenalectomy. Opening pressures on insertion were high. Respiratory and cardiovascular changes alerted the anesthesiologists to the possibility of CO2 embolism. The patient was treated with inotropic drugs, placed in Durant’s position, and the operation was aborted. Ultrasound demonstrated gas bubbles within the liver parenchyma and the heart chambers. The patient was transferred to the surgical intensive care unit where she experienced a grand mal seizure. She was later taken to a nearby hospital for hyperbaric oxygen therapy during which she suffered 3 additional seizures. She had subsequent resolution of all neurological symptoms.

The first entry into the peritoneum deserves the full attention of the operating room team, because this is when most CO2 embolisms occur. The team should be prepared to take immediate action on suspicion of embolism. Gas embolism can occur not only by direct cannulation of blood vessels, but also by injury to solid organs, especially the liver. All overweight patients should be suspected of having hepatomegaly and the location of initial entry into the peritoneum should shift accordingly. In selected patients, one should use a direct visualization approach, because this approach has fewer complications and they are more readily identified.

Key Words: Adrenalectomy, Carbon dioxide, Embolism, Laparoscopy, Liver.

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Melanoma and Sarcomas Unit, Veneto Institute of Oncology IOV—IRCCS, Padova, Italy (Drs. Sommariva, Tropea, Rossi). Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy (Dr. Pasquali). Department of Medical Diagnostic Sciences and Special Therapies, University of Padova, Padova, Italy (Dr. Stramare). Pathology Unit, Veneto Institute of Oncology IOV—IRCCS, Padova, Italy (Dr. Montesco).

ABSTRACT

Accessory liver lobe (ALL) is a rare congenital abnormality characterized by the presence of hepatic tissue outside of, but attached to, the liver. ALL is usually asymptomatic, but in the case of torsion, it can be confused with an acute surgical emergency or a tumoral mass. Conventional imaging is often inconclusive, and diagnosis is generally made during laparotomy. We report the case of a patient with left ALL torsion who, for the first time, was successfully diagnosed and treated with a laparoscopic resection.

Key Words: Congenital abnormalities, Laparoscopy, Liver, Radiology.

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The post Rhabdomyolysis During Laparoscopic Hepatic Subsegmentectomy first appeared on CRSLS.

Department of Surgery, Singapore General Hospital, Singapore (all authors). Duke-NUS Graduate Medical School, Singapore (Dr. Goh).

ABSTRACT

Synchronous resection of primary neuroendocrine tumors (NET) with liver metastases remains controversial, although recent studies have demonstrated its safety in select patients. Synchronous laparoscopic gastric and liver resection has been rarely reported. We report the case of a 65-year-old man who underwent successful simultaneous D2 subtotal gastrectomy with hepatectomy and cholecystectomy for metastatic gastric NET. This is the first reported case of totally laparoscopic simultaneous D2 gastrectomy with hepatectomy and cholecystectomy for metastatic gastric NET. Laparoscopic simultaneous gastrectomy and hepatectomy is feasible and safe in select patients with metastatic gastric NET.

Key Words: Laparoscopy, Hepatectomy, Gastrectomy, Simultaneous, Neuroendocrine tumor, liver, gastric, resection, carcinoid.

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The post Totally Laparoscopic D2 Subtotal Gastrectomy with Hepatectomy and Cholecystectomy for Gastric Neuroendocrine Tumor with Liver Metastases first appeared on CRSLS.