title: Overcoming reduced hepatic and renal perfusion caused by positive-pressure pneumoperitoneum.
abstract: OBJECTIVE
  Use of the intermittent sequential pneumatic compression (ISPC) device may improve splanchnic and renal perfusion caused by positive-pressure pneumoperitoneum (PPP) in patients undergoing laparoscopic cholecystectomy.
  
  
  METHODS
  Prospective controlled study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Twenty-two consecutive patients undergoing elective laparoscopic cholecystectomy whose cardiac output decreased at least 10% on induction of PPP.
  
  
  METHODS
  The ISPC device was activated over the lower limbs 15 minutes after PPP was established for the remainder of surgery.
  
  
  METHODS
  Urine output, cardiovascular functions, and hepatic and renal perfusion were measured during the surgical phases; urine output was quantified in a matched control group (n = 30).
  
  
  RESULTS
  Induction of PPP significantly decreased cardiac output and stroke volume, while ISPC significantly reversed these changes. Increased systemic vascular resistance during PPP was reversed by ISPC. Activation of the pneumatic sleeves during PPP increased the mean +/- SD portal venous and hepatic arterial blood flows from 0.86 +/- 0.30 to 1.33 +/- 0.44 L/min (P<.001) and from 0.26 +/- 0.10 to 0.38 +/- 0.19 L/min (P = .002), respectively; the mean renal segmental arterial index decreased with ISPC from 0.68 +/- 0.05 to 0.63 +/- 0.08 (P = .003). During PPP, urine output decreased from 1.10 to 0.28 mL/min per meter squared (P = .001) but improved markedly with ISPC to 0.61 mL/min per meter squared (P = .01). Such improvement was absent in the control group.
  
  
  CONCLUSIONS
  Use of ISPC significantly improves hepatic and renal blood flows during PPP. Its application is recommended during prolonged laparoscopic procedures, including laparoscopic live donor nephrectomy.
authors.affiliation: The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. amitai@netvision.net.il
authors.forename: Amitai
authors.initials: A
authors.lastname: Bickel
authors.forename: Norman
authors.initials: N
authors.lastname: Loberant
authors.forename: Marina
authors.initials: M
authors.lastname: Bersudsky
authors.forename: Moshe
authors.initials: M
authors.lastname: Goldfeld
authors.forename: Shimon
authors.initials: S
authors.lastname: Ivry
authors.forename: Miryam
authors.initials: M
authors.lastname: Herskovits
authors.forename: Arie
authors.initials: A
authors.lastname: Eitan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000502:physiology*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041761:Cholecystolithiasis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011312:Pressure; D011446:Prospective Studies; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014563:Urodynamics / Q000502:physiology*; D014655:Vascular Resistance / Q000502:physiology*