Article

Evidence of venous stasis after abdominal insufflation for laparoscopic cholecystectomy. Anesthesiology 77 (3A): 148

Department of Anesthesiology, University of Minnesota Hospital and Clinic, Minneapolis.
Surgery, gynecology & obstetrics 05/1993; 176(5):443-7. DOI: 10.1097/00000542-199209001-00148
Source: PubMed

ABSTRACT Intraoperative venous stasis may increase the risk for perioperative deep vein thrombosis and pulmonary embolism. To determine if abdominal insufflation during laparoscopic cholecystectomy causes venous stasis, eight patients undergoing this procedure had their left common femoral veins examined by a duplex scanner before and after abdominal insufflation; the veins then were examined again before and after deflation. The right femoral veins were catheterized to measure femoral venous pressures. Abdominal insufflation to 14 millimeters of mercury pressure increased femoral venous pressures (10.2 +/- 4.1 millimeters of mercury to 18.2 +/- 5.1 millimeters of mercury; p < 0.001) and slowed peak blood velocities (24.9 +/- 8.5 centimeters per second to 18.5 +/- 4.5 centimeters per second; p < 0.05) without changing the cross-sectional areas (1.1 +/- 0.4 centimeter squared to 1.2 +/- 1.5 centimeter squared; p = NS) of the common femoral veins. Insufflation also reduced or eliminated pulsatility in the common femoral veins in 75 percent of the patients, indicating that insufflation was causing partial proximal venous obstruction. After 80 +/- 21 minutes of surgery, these changes remained significant. Deflation of the abdomen restored normal venous pulsatility in all patients, reduced femoral venous pressures (18.5 +/- 5.2 millimeters of mercury to 12.2 +/- 9.8 millimeters of mercury; p < 0.001), increased the peak blood velocities (14.2 +/- 6.8 centimeters per second to 28.1 +/- 16 centimeters per second; p < 0.05) and decreased the cross-sectional areas (1.4 +/- 0.6 centimeters squared to 0.9 +/- 0.4 centimeters squared; p < 0.05) of the common femoral veins, indicating venous decompression had occurred. The results suggest abdominal insufflation causes venous stasis during laparoscopic cholecystectomies. Measures shown to reduce intraoperative venous stasis, such as pneumatic compressive stockings, may benefit patients undergoing these procedures.

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    • "These reports suggest that the DVT risk in urologic laparoscopic surgery appears to be lower, but accurate DVT rates may be higher if screening imaging techniques are utilized rather than clinical observations. Although increasing accumulating evidence demonstrates that DVT does not occur more often with laparoscopic surgery than with open procedures, the abdominal insufflation used during laparoscopic procedures has been proposed to cause serum hypercoagulability of varying degrees and VTE secondary to venous stasis with a concomitant higher risk of DVT and PE [8] [9]. In addition, the patient's position such as the lateral flank position during kidney and adrenal surgeries and the lithotomy position during prostate and urinary bladder surgeries may be another risk factor that predisposes to decreased venous return and increased VTE risk. "
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    • "Several other scientists (Ido et al.,1995; Jorgensen et al., 1994; Beebe et al., 1993) also investigated femoral vein blood flow velocities during and after abdominal insufflation in patients, who underwent laparoscopic cholecystectomy, using color Doppler ultrasonography. They also found, that abdominal insufflation reduced the blood velocity in the femoral vein and suggested that abdominal insufflation during laparoscopic operation can cause femoral vein stasis. "
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