Abstract
Background
Pneumoperitoneum and patient positioning are essential factors during laparoscopic surgical procedures. They cause hemodynamic and anatomical changes in several abdominal organs among which the caudal cava vein (CCV) is involved. Hemodynamic changes in this vein (decreased venous return) have been described in the porcine model, but how the vein morphology and size is affected at different abdominal levels is unknown. We sought to assess the morphological and morphometrical changes in the CCV of the pig caused by pneumoperitoneum and the reverse Trendelenburg position by in vivo magnetic resonance imaging (MRI).
Methods
Six pigs were scanned via MRI under four situations: S1, control (no pneumoperitoneum); S2, control in the reverse Trendelenburg position; S3, pneumoperitoneum (14 mmHg); and S4, pneumoperitoneum in the reverse Trendelenburg position. MRI and plastinated body sections were used to evaluate the topography, morphology and cross-sectional area of the CCV.
Results
Two portions of the CCV were differentiated: a prehepatic portion (located between the vertebral levels L1–T15) with flat and irregular morphology, and a hepatic portion (between T14–T11) that was almost rounded. The reverse Trendelenburg position caused an increase in the lumen affecting mainly the prehepatic portion, while pneumoperitoneum caused a decrease in the total vascular lumen, exerting a greater effect on the hepatic portion. The combination of both situations resulted in a further decrease in the vascular area and global morphological changes.
Conclusions
The pneumoperitoneum and reverse Trendelenburg position caused morphological and morphometrical changes in the prehepatic and hepatic portions of the CCV, which should assist in gaining a better understanding of the hemodynamic changes described in the literature.
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Acknowledgments
This study was funded by INNAVLAP (CIT-300100-2007-55) from the Ministerio de Ciencia e Innovación, Spain. This work has also been partially funded by the Junta Extremadura, Consejería de Economía, Comercio e Innovación and European Social Fund (TEC08095).
Disclosures
Drs. E. Párraga, O. López-Albors, F. . Sánchez-Margallo, J. L. Moyano-Cuevas, and R. Latorre have no conflicts of interest or financial ties to disclose.
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Párraga, E., López-Albors, O., Sánchez-Margallo, F. et al. Effects of pneumoperitoneum and body position on the morphology of the caudal cava vein analyzed by MRI and plastinated sections. Surg Endosc 27, 880–887 (2013). https://doi.org/10.1007/s00464-012-2528-5
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DOI: https://doi.org/10.1007/s00464-012-2528-5