During surgical laparoscopy, total hepatic blood flow (THBF) may be modified by CO₂ insufflation, changes of tilt, ventilation with high tidal volume, hypercapnia, and anesthesia, but little information is available on the THBF during the procedure. To investigate the changes of hepatic blood flow following the combination of abdominal CO₂ insufflation and changes of tilt, we measured mean arterial pressure (MAP), cardiac output, portal vein blood flow (PVBF), and hepatic artery blood flow (HABF) in anesthetized and ventilated pigs. CO₂ was insufflated in the abdomen [intra-abdominal pressure (IAP) ~15 mmHg], and the hepatic blood flow was measured in various positions (horizontal, 10° and 20° head down, and 10° and 20° head up) before and during CO₂ insufflation. CO₂ insufflation in the horizontal position did not modify MAP, cardiac output, or PVBF but increased HABF. The head-up tilt decreased MAP, cardiac output, and both hepatic flows in the absence of pneumoperitoneum, but in the presence of abdominal CO₂ only cardiac output and PVBF were decreased. The head-down tilt increased MAP and THBF in the absence of pneumoperitoneum, whereas no change was observed in the presence of abdominal CO₂. The combination of CO₂ insufflation and changes of tilt was not deleterious to hepatic perfusion. These results suggest that hepatic blood flow may be preserved during surgical laparoscopy if the tilt does not exceed 20° and if IAP after CO₂ insufflation remains <15 mmHg.