Saline-filled laparoscopic surgery: A basic study on partial hepatectomy in a rabbit model

Background: There is still a poor understanding of the effects of pneumoperitoneum with insufflation of carbon dioxide gas (CO₂) on malignant cells, and pneumoperitoneum has a negative impact on cardiopulmonary responses. A novel saline-filled laparoscopic surgery (SAFLS) is proposed, and the technical feasibility of performing saline-filled laparoscopic partial hepatectomy (LPH) was evaluated in a rabbit model. Material and methods: Twelve LPH were performed in rabbits, with six procedures performed using an ultrasonic device with CO₂ pneumoperitoneum (CO₂ group) and six procedures performed using a bipolar resectoscope (RS) in a saline-filled environment (saline group). Resection time, CO₂ and saline consumption, vital signs, blood gas analysis, complications, interleukin-1 beta (IL-1β) and C-reactive protein (CRP) levels were measured. The effectiveness of the resections was evaluated by the pathological findings. Results: LPH was successfully performed with clear observation by irrigation and good control of bleeding by coagulation with RS. There were no significant differences in all perioperative values, IL-1βand CRP levels between the two groups. All pathological specimens of the saline group showed that the resected lesions were coagulated and regenerated as well as in the CO₂ group. Conclusions: SAFLS is feasible and provides a good surgical view with irrigation and identification of bleeding sites.