Computed tomography determined changes in position of the hepatobiliary and gastrointestinal systems after CO2 insufflation to determine optimal positioning for abdominal laparoscopy

Abstract

OBJECTIVE : To evaluate changes in body position and effect of CO2 insufflation on the hepatobiliary and gastrointestinal systems using computed tomography (CT) to determine optimal laparoscopic approach. STUDY DESIGN : Experimental study. ANIMALS : Healthy intact female Beagles (n = 6) of similar age, weight, and body condition score. METHODS : Urinalysis, peripheral blood smear, and abdominal ultrasonography were performed to determine dog health. A series of pre insufflation (PrI) CT scans in ventrodorsal routine (VDR), ventrodorsal Trendelenburg (VDT), left lateral (LL), and right lateral (RL) recumbency were performed before and after abdominal insufflation (PoI) with CO2 (10–14 mm Hg). Pre-determined measurements were made on PrI and PoI scans and differences compared.Results: Liver position was affected by body position and under gravitational influence moved to the dependent part of the abdominal cavity. The gallbladder was best exposed in LL. Stomach position was not significantly changed after insufflation. Different areas of small intestine were dependent on gravitational effects. The pancreas maintained a similar position after insufflation. CONCLUSIONS : VDR was the ideal position for all laparoscopic procedures of the liver. The LL position could be used for surgery of the gallbladder but likely provides poor exposure to the rest of the liver. In approaching the stomach and intestines, the area of interest should be used to determine the best position.