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Open Access

A new model of uncontrolled hepatic hemorrhage from trocar insertion simulating iatrogenic lesions during video-assisted surgeries

  • MO Taha1,
  • JH Soares1,
  • PS Venerando1,
  • ACC Gandolfi1,
  • JB Tsuchya1,
  • A Caricati-Neto1 and
  • LF Poli de Figueiredo1
Critical Care20059(Suppl 2):P122

https://doi.org/10.1186/cc3666

Published: 9 June 2005

Keywords

Blood LossLiver InjuryMean Arterial PressureLiver LesionHemostatic Agent

Background

Visceral iatrogenic lesions during video-assisted surgeries may occur during the blind insertion of trocars. Life-threatening hemorrhage and conversion to open surgery may occur. The use of topical hemostatic agents may control the hemorrhage and avoid the need for laparotomy. Our goal is to develop a model simulating liver injury produced by trocar insertion.

Methods

Ten male Landrace pigs weighing 16–20 kg were anesthetized and submitted to pneumoperitonium using CO2 for introduction of a laparoscopic camera into the abdominal cavity. Under direct vision, the anterior surface of the right hepatic iver lobe was perforated by a trocar. The animals were previously divided into two groups: controls (n = 5) and heparin (n = 5), in which 200 UI/kg heparin was administrated intravenously 10 min before the liver lesion, simulating a coagulopathic scenario. Before (0 min) and 10 or 20 min after induction of the liver lesion, hematologic and hemodynamic parameters including hematocrit (Ht), mean arterial pressure (MAP), cardiac output (l/min) and intra-abdominal blood loss (ml) were determined.

Results

See Table 1 and Fig. 1.

Table 1

 

Group

0 min

10 min

20 min

Ht (%)

Control

26.6 ± 0.9

26.6 ± 1.0

26.4 ± 0.9

 

Heparin

28.4 ± 0.6

25.2 ± 1.7

26.6 ± 1.6

MAP (mmHg)

Control

89.4 ± 6.9

76.4 ± 8

76.4 ± 4

 

Heparin

87 ± 14

44 ± 17*

42.2 ± 17*

Cardiac output (l/min)

Control

5.1 ± 0.7

4.0 ± 0.6

4.23 ± 07

 

Heparin

5.8 ± 0.4

2.7 ± 1.1*

2.73 ± 1.4*

Data presented as the mean ± SEM; * P < 0.05 compared with controls.

Figure 1

Figure 1

Conclusion

We conclude that trocar-induced liver injury promotes limited blood loss, discrete hypotension and a minor decrease in cardiac output. The use of heparin promotes a significant increase in blood loss and severe hemodynamic compromise. Both models may be useful to test interventions to stop bleeding and to reverse hemodynamic instability due to uncontrolled hemorrhage.

Authors’ Affiliations

(1)
Department of Surgery and Department of Pharmacology, Federal University of São Paulo, Brazil

Copyright

© BioMed Central Ltd 2005

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