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

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
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.

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Taha, M., Soares, J., Venerando, P. et al. A new model of uncontrolled hepatic hemorrhage from trocar insertion simulating iatrogenic lesions during video-assisted surgeries. Crit Care 9 (Suppl 2), P122 (2005). https://doi.org/10.1186/cc3666

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  • DOI: https://doi.org/10.1186/cc3666

Keywords

  • Blood Loss
  • Liver Injury
  • Mean Arterial Pressure
  • Liver Lesion
  • Hemostatic Agent