title: Effects of patient position on lower extremity venous pressure during different types of hysterectomy.
abstract: OBJECTIVE
  To explore the effects of different types of hysterectomy on lower extremity venous pressure.
  
  
  METHODS
  Ninety-nine patients with benign uterine diseases who were indicated for hysterectomy were included in the present prospective study. Patients were divided into three groups according to their preferences: (i) total laparoscopic hysterectomy (TLH) group (n = 36); (ii) transvaginal hysterectomy (TVH) group (n = 32); and (iii) transabdominal hysterectomy (TAH) group (n = 31). Lower extremity venous pressure was monitored using a pressure sensor during the surgery.
  
  
  RESULTS
  Compared with the supine position (TAH group, lower extremity venous pressure of intraoperative 16.50 cmH2 O), lower extremity venous pressure of the improved lithotomy position (TLH group, lower extremity venous pressure of intraoperative 53.27 cmH2 O) and conventional lithotomy position (TVH group, lower extremity venous pressure of intraoperative 42.09 cmH2 O) were significantly increased (P < 0.01).Venous pressure was reduced when patients lowered their heads by 15° or 5° in modified or conventional lithotomy positions, respectively (P < 0.01). Venous pressure was increased significantly after the establishment of pneumoperitoneum in the TLH group (P < 0.01).
  
  
  CONCLUSIONS
  Modified lithotomy position (TLH group) and conventional lithotomy position (TVH group) and CO2 pneumoperitoneum may result in increased lower extremity venous pressure during hysterectomy. Furthermore, elevated venous pressure can be altered by changing the intraoperative position. Specifically, intraoperative positioning of the lower extremities represents a modifiable risk factor for deep venous thrombosis.
authors.affiliation: Department of Obstetrics and Gynecology, Laiwu People's Hospital, Laiwu, China; Department of Obstetrics and Gynecology, Clinical Medicine Academy of Taishan Medical University, Taian, China.
authors.forename: Xiaoxia
authors.initials: X
authors.lastname: Liu
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Wang
authors.forename: Xianhua
authors.initials: X
authors.lastname: Meng
authors.forename: Hongping
authors.initials: H
authors.lastname: Wang
authors.forename: Zengshun
authors.initials: Z
authors.lastname: An
mesh_terms: D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D010535:Laparoscopy; D035002:Lower Extremity / Q000098:blood supply; D008875:Middle Aged; D011446:Prospective Studies; D014690:Venous Pressure
keywords: operation position; pneumoperitoneum; total hysterectomy; venous pressure; venous stasis