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
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.
Available from: Fuminori Sato
- "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  . 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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ABSTRACT: There is a paucity of definitive evidence that supports the use of enoxaparin to prevent venous thromboembolism (VTE) after urologic laparoscopic surgery. The purpose of this study was to evaluate the efficacy and safety of postoperative subcutaneous enoxaparin injection in patients who underwent urologic laparoscopic surgery. A total of 63 patients were evaluated from June 2010 to December 2012. All patients received postoperative prophylaxis with enoxaparin (2000 IU twice daily for 5 days). None of the patients treated with enoxaparin developed symptomatic VTE, but two cases (3.2%) of pulmonary embolism were noted before initial enoxaparin administration. Statistically significant differences were observed between the prothrombin time (PT) and activated partial thromboplastin time (APTT) values and D-dimer levels obtained at baseline and on day 7 after surgery; however, the PT and APTT values did not exceed the normal range. In addition, signs of any adverse events were not encountered in any of the patients treated with enoxaparin. The use of enoxaparin immediately after a surgery may confer valuable thromboprophylaxis benefits for urologic laparoscopic surgery.
Available from: Mindaugas Kiudelis
- "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. "
Available from: Frank Branicki
- "Second, there was significant dilatation of the femoral vein. Those findings are in keeping with the observations of other authors.9–11 No DVT could be detected postoperatively in our series, and all duplex scans performed postoperatively demonstrated a reversal to normal of the changes seen intraoperatively. "
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ABSTRACT: There is widespread concern that laparoscopic procedures that are usually performed under general anesthesia, using muscle relaxation, in a reverse Trendelenberg position and with pneumoperitoneum, may lead to venous stasis in lower limbs.
To evaluate perioperative changes in the venous system and determine the frequency of deep venous thrombosis associated with minimally invasive surgery.
Prospective consecutive series.
Sixty-five patients undergoing elective minimally invasive surgery.
Laparoscopic procedures with no thromboprophylaxis.
Sixty-one patients completed the investigations (coagulation profile and lower limb venous duplex scan) on admission and on the first postoperative day. The median duration of pneumoperitoneum was 45 minutes (range: 18-90 minutes). None of postoperative scans revealed thrombosis. No significant changes in the postoperative coagulation profile were identified. Perioperative scans of the left femoral vein revealed an increase in cross-sectional area (P<0.05) and a decrease in peak blood velocity (P<0.05).
In this study of low-risk patients for thromboembolism, laparoscopy with pneumoperitoneum at pressures below 12 mm Hg per se did not increase the prevalence of deep venous thrombosis. This implies that venous hemodynamic changes observed during pneumoperitoneum did not cause deleterious venous stasis. Still, caution needs to exercised with regard to the view that no special precautions to prevent deep venous thrombosis are warranted in patients undergoing laparoscopy.
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