Research progress on carbon dioxide embolism during laparoscopic liver resection

Laparoscopic liver resection (LLR) is currently the first-line treatment for multiple liver diseases. Although clinical data have proven its safety and effectiveness, bleeding and carbon dioxide (CO 2 ) embolism are still the major complications of LLR. The objective of this review was to summarize the pathogenetic mechanism, clinical manifestations, risk factors, prophylactic measures, and treatment strategies for CO 2 embolism in the LLR and propose further research directions regarding these controversial issues. A narrative review of the literature from three databases, including PubMed, Embase and Web of Science, was conducted without any date or language restrictions. The search terms included CO 2 embolism, gas embolism, laparoscopy, liver resection, and hepatectomy. The incidence of CO 2 embolism in LLR (1.2%–4.6%) is approximately 10 times greater than that in overall laparoscopic surgery (0.15%). Transesophageal echocardiogram is currently considered the gold standard for identifying CO 2 embolism. Risk factors are multifactorial and involve patient characteristics, procedural techniques, and anesthetic management. Presently, in clinical practice, a pneumoperitoneal pressure of 10–15 mmHg is typically used to balance bleeding and CO2 embolism during LLR. The majority of observed CO 2 embolism events are benign, with no significant clinical impact on short-term or long-term outcomes. However, meticulous monitoring, timely recognition, and prompt intervention are crucial during LLR to prevent life-threatening events. Future research should further refine risk stratification, validate early detection methods, and develop standardized management protocols for CO 2 embolism in LLR.