Author/Editor		Požar-Lukanovič, Neva; Sojar, Valentin; Stanisavljevič, Dragoje
Title		Haemodynamic monitoring during laparoscopic liver resection
Translated title		Hemodinamski nadzor med laparoskopsko jetrno resekcijo
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 10, št. 24
Publication year		2005
Volume		str. 89-94
Language		eng
Abstract		Introduction. Minimally invasive surgery has been gaining popularity because of its clear advantages over open surgery, which include: lesser surgical trauma, shorter hospital stay, better cosmetical effect and improved patient satisfaction. Greater experience gained in both laparoscopy and liver surgery has made laparoscopy a technically feasible and safe treatment option for some liver resections. Patients and Methods. Haemodynamic monitoring during minimally invasive surgery: the term "minimally invasive surgery" does not imply that this surgical technique carries less perioperative risk for the patient. Perioperative hazards of laparoscopic liver resection are mostly the same as in open liver surgery. These include: massive bleeding, haemodynamic instability due to compression of the inferior vena cava anaphylactic reaction in patients with echinococcus disease. In addition, there may be haemodynamic effects of pneumoperitoneum, such as decreased preload, increased systemic vascular resistance, decreased cardiac output, and increased risk for CO2 embolism. The greatest benefits offered by the minimally invasive approach are the patients comfort and safety. From the standpoint of the anaesthesiologist this goal is best met by perioperative monitoring, which allows for timely detection of potentially dangerous events and for appropriate action. Results. Since January 1997, 31 patients with liver disease have been treated laparoscopicaly in this institution. In three cases, occlusion of the hepatoduodenal ligament was used to control the bleeding. In one patient-the only one who needed blood transfusion-conversion to open surgery was required because of bleeding. (Abstract truncated at 2000 characters)
Summary		Uvod. V zadnjih letih so minimalno invazivni postopki v kirurgiji vse bolj priljubljeni. V primerjavi s klasičnimi operacijami je kirurška poškodba manjša, bolniki ostanejo v bolnišnici manj časa, kozmetični videz je manj prizadet in bolniki so bolj zadovoljni. Zaradi novih znanj in izkušenj v jetrni kirurgiji in laparoskopskih tehnikah je nekatere jetrne resekcije možno varno narediti na laparoskopski način. Bolniki in metode. Nadzor obtočil med minimalno invazivnimi operacijami: pojem «minimalno invazivna kirurgija« ne vključuje tudi minimalnega tveganja za bolnika med posegom. Tveganje med laparoskopsko jetrno resekcijo (LJR) je enako kot med klasičnim posegom: obsežna krvavitev, hemodinamska nestabilnost in anafilaktična reakcija pri bolnikih z ehinokoknimi spremembami v jetrih. Tem zapletom se pridružijo še hemodinamski učinki pnevmoperitoneja: zmanjšan pritok krvi v srce, povečan upor ožilja, zmanjšan minutni volumen srca (MV) in nevarnost embolije s CO2. S stališča anesteziologa zagotovimo bolniku največjo varnost z nadzorom, ki omogoča hitro zaznavo in pravočasno ukrepanje ob zapletih. Rezultati. Od januarja 1997 smo laparoskopsko operirali 31 bolnikov z boleznijo jeter. Pri treh bolnikih smo zaradi kontrole hemostaze uporabili zaporo hepatoduodenalnega ligamenta. Pri enem bolniku - ta je bil edini, ki je potreboval transfuzijo krvi - smo morali preklopiti v odprt kirurški poseg. Zaključek. Glede na trenutne možnosti minimalno invazivni nadzor pri LJR ni priporočljiv. Hitre spremembe hemodinamike terjajo invazivno merjenje krvnega tlaka in i.v. port s širokim premerom za zdravljenje s tekočinami in transfuzijo krvnih pripravkov. (Izvleček skrajšan na 2000 znakov)
Descriptors		HEPATECTOMY SURGERY, LAPAROSCOPIC HEMODYNAMICS CARBON MONOXIDE