Maintaining pneumoperitoneum pressure in laparoscopic liver resection is important not only for securing a good surgical field and working space, but also for bleeding control.

AirSeal® (air seal mode) is a useful device for maintaining stable pneumoperitoneum despite intraperitoneal suction by continuously monitoring and adjusting the CO2 flow rate. A clinical case of gas embolism when using AirSeal® has been reported in papers and presentations at academic societies and research societies1.

Although it may depend on the balance between respiratory and circulatory management (airway pressure, central venous pressure) and pneumoperitoneum pressure, one of the causes is thought to be the sudden increase in CO2 flow when sucking the abdominal cavity. In addition, there are reports in experiments and clinical cases that the pressure is maintained by taking in air in the operating room as the pneumoperitoneum pressure drops rapidly during suction, and there is concern about the development of air embolism 2 3.

Based on the above, we would like you to recognize the points to note regarding pneumoperitoneum using AirSeal® (air seal mode) in laparoscopic and robot-assisted hepatectomy, and to perform appropriate operations. The Society for Endoscopy Surgery will issue a warning.

  1. Kajiwara M, Nakashima R, Yoshimura F, Hasegawa S. Impact of AirSeal® insufflation system on respiratory and circulatory dynamics during laparoscopic abdominal surgery. Updates Surg. 2022; 74: 2003-2009.
  2. Huntington CR, Prince J, Hazelbaker K, Lopes B, Webb T, LeMaster CB, Huntington TR. Safety first: significant risk of air embolism in laparoscopic gasketless insufflation systems. Surg Endosc. 2019; 33: 3964-3969.
  3. Weenink RP, Kloosterman M, Hompes R, Zondervan PJ, Beerlage HP, Tanis PJ, van Hulst RA. The AirSeal® insufflation device can entrain room air during routine operation. Tech Coloproctol. 2020 Oct;24(10):1077-1082.