Venous stasis during laparoscopic cholecystectomy.
The objectives of this research were (a) to determine the effect of insufflation at laparoscopic cholecystectomy to 12 mm Hg on femoral venous blood flow; and (b) to assess the function of intermittent pneumatic compressors (IPC) and intermittent electric calf stimulators (IECS) in the presence of a pneumoperitoneum. Measures of baseline venous blood flow velocity, femoral vein diameter, and maximum blood flow velocity achieved by IPC or IECS were made in the presence or absence of a pneumoperitoneum of 12 mm Hg. The ICP and IECS were randomly allocated to either leg. All measures were made by an experienced sonologist. Insufflation to 12 mm Hg caused a statically significant decrease in femoral blood flow velocity and was accompanied by a significant increase in femoral vein diameter. The IPC and IECS were able to achieve pulsatile venous blood flow despite the presence of a pneumoperitoneum, but they had no effect on the depressed baseline blood flow velocity. We concluded that insufflation to 12 mm Hg causes significant venous stasis in the lower limb and that IPC and IECS cannot completely eliminate this stasis. Further research needs to be done to clarify the optimal methods of prophylaxis in view of the implications for deep venous thrombosis.
Jorgensen
J O
JO
Department of Surgery, St. George Hospital, Sydney, New South Wales, Australia.
Lalak
N J
NJ
North
L
L
Hanel
K
K
Hunt
D R
DR
Morris
D L
DL
D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D005268:Femoral Vein / Q000502:physiology; D006801:Humans; D007327:Insufflation / Q000009:adverse effects; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D011312:Pressure; D013924:Thrombophlebitis / Q000209:etiology; D014689:Venous Insufficiency / Q000209:etiology*