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Influence of patient positioning and pneumoperitoneum on lower limbs venous haemodynamics during laparoscopic cholecystectomy

  • Clinical Study
  • Published:
Hellenic Journal of Surgery

Abstract

Aim-Background

The introduction of laparoscopic surgery has dramatically changed the management of gallstone disease, establishing laparoscopic cholecystectomy as the method of choice for treating cholelithiasis. The aim of this study is to review the significance of patient positioning and pneumoperitoneum in laparoscopic cholecystectomy as potential risk factors for the development of postoperative venous thromboembolism (VTE), with the use of impedance plethysmography (IPG).

Patients and Methods

We studied 40 consecutive patients undergoing selective laparoscopic cholecystectomy. Seventeen patients of our study group were positioned on the operating table in the lithotomy (French) position and 23 in the supine (American) position. Femoral venous capacitance (VC) and maximum venous outflow (MVO) from both legs of the patient was obtained using an impedance ple-thysmography (IPG) device. These parameters were measured: a) the day before operation, b) after French or American positioning on the surgical table, c) at the time of inflation to produce pneumoperitoneum, d) 30 minutes after pneumoperitoneum, and e) 24 hours after surgery.

Results

Our study confirms that the patient’s position on the surgical table (French or American position) does not affect venous haemodynamics of the legs. Peritoneal carbon dioxide insufflations to an intrabdominal pressure of 12 mm Hg produce haemodynamic changes, significantly increased after the beginning of peritoneal insufflations.VC and MVO were significantly increased during surgery in both positions. However, after exsufflation and at the first postoperative day, all haemodynamic parameters returned to preoperative values.

Conclusion

Our study advocates no difference between French or American positioning during laparoscopic cholecystectomy in measurements obtained from both legs of the patient using an impedance plethysmography device.

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References

  1. Lindberg F, Bergqvist D, Rasmussen I (1997) Incidence of thromboembolic complications after laparoscopic cholecystectomy: Review of the literature. Surg Laparosc Endosc 7:324–331

    Article  PubMed  CAS  Google Scholar 

  2. Deziel DJ, Millikan KW, Economou SG, Doolas A, Sung TS, Airan MC (1993) Complications of Laparoscopic Cholecystectomy. A national survey of 4292 hospitals and an analysis of 77604 cases. Am J Surg 165: 9–14

    Article  PubMed  CAS  Google Scholar 

  3. Soper NJ, Brunt ML, Kerbl K (1994) Laparoscopic general surgery. N Engl J Med 330:409–419

    Article  PubMed  CAS  Google Scholar 

  4. Barnes GE, Laine GA, Giam PY, et al (1985) Cardiovascular response to elevation of intrabdominal hydrostatic pressure. Am J Physiol 248: R208–R213.

    PubMed  CAS  Google Scholar 

  5. Goodale RL, Beebe DS, McNevin M, et al (1993) Hemodynamic, respiratory and metabolic effects of laparoscopic cholecystectomy. Am J Surg 166:533–537.

    Article  PubMed  CAS  Google Scholar 

  6. Schietroma M, Carlei F, Mownah A, Franchi L, Mazzotta C, Sozio A (2004) Changes in the blood coagulation, fibrinolysis, and cytokine profile during laparoscopic and open cholecystectomy. Surg Endosc. 18(7):1090–1096

    Article  PubMed  CAS  Google Scholar 

  7. Caprini JA, Arcelus JI, Laubach M, Size G, Hoffman KN (1995) Postoperative Hypercoagulability and Deep-Vein Thrombosis after Laparoscopic Cholecystectomy. Surg Endosc 9(3): 304–309.

    PubMed  CAS  Google Scholar 

  8. Healey MG, Maher PJ, Hill DJ (1998) The Risk of Venous Thrombosis Following Gynecological Laparoscopic Surgery. Med J Aust, 168(10): 524

    PubMed  CAS  Google Scholar 

  9. Sobolewski AP, Deshmukh RM, Brunson BL (1995) Venous hemodynamic changes during Laparoscopic Cholecystectomy. J Laparoendosc Surg. 5(6): 363–369

    Article  PubMed  CAS  Google Scholar 

  10. Gensini GF, Prisco D, Falciani M, Comeglio M, Colella A, (1997) Identification of Candidates for Prevention of Venous Thromboembolism. Semin Thromb Hemost 23(1): 55–67.

    Article  PubMed  CAS  Google Scholar 

  11. Cramer M, Langlois Y, Beach K, Martin D, Strandness DE Jr (1983) Standardization of venous flow measurement by strain gauge plethysmography in normal subjects. Bruit 7, 33–40.

    Google Scholar 

  12. NIH (1986) Consensus conference on prevention of venous thrombosis and pulmonary embolism. JAMA 256:744–748

    Article  Google Scholar 

  13. Anderson FA Jr, Spencer FA (2003) Risk factors for venous thromboembolism. Circulation 107: I9–I16.

    Article  PubMed  Google Scholar 

  14. Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Forcier A (1992) The prevalence of risk factors for venous thromboembolism among hospital patients. Arch Intern Med 152: 1660–664.

    Article  PubMed  Google Scholar 

  15. Gerotziafas GT, Samama MM (2004) Prophylaxis of venous thromboembolism in medical patients. Curr Opin Pulm Med. 10:356–365

    Article  PubMed  CAS  Google Scholar 

  16. Neudecker J, Sauerland S, Neugebauer E, et al (2002) The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc 16: 1121–43.

    Article  PubMed  CAS  Google Scholar 

  17. Mall JW, Schwenk W, Rödiger O, Zippel K, Pollmann C, Müller JM. (2001) Blinded prospective study of the incidence of deep venous thrombosis following conventional or laparoscopic colorectal resection Br J Surg 88: 99–100.

    Article  PubMed  CAS  Google Scholar 

  18. Schaepkens Van Riempst JT, Van Hee RH, Weyler J (2002) Deep venous thrombosis after laparoscopic cholecystectomy and prevention with nadroparin. Surg Endosc 16: 184–187.

    Article  PubMed  CAS  Google Scholar 

  19. Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA, Wheeler HB (2001) Prevention of venous thromboembolism. Chest 119: 132S–175S.

    Article  PubMed  CAS  Google Scholar 

  20. Collins R, Scrimgeour A, Yusuf S, Petro R (1988) Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. N Engl J Med 318

    Google Scholar 

  21. Beekman R, Crowther M, Farrokhyar F, Birch D W (2006) Practice patterns for deep vein thrombosis prophylaxis in minimalaccess surgery. Canadian Journal of Surgery. Publication

    Google Scholar 

  22. Zacharoulis D, Kakkar A (2003) Venous thromboembolism in laparoscopic surgery. Current Opinion in Pulmonary Medicine. 9(5): 356–361

    Article  PubMed  Google Scholar 

  23. Catheline JM, Gaillard JL, Rizk N, Barrat C, Champault G (1998) Facteurs de risqué prevention du risqué thrombo-embolique en laparoscopie. Ann Chir 52: 890–895.

    PubMed  CAS  Google Scholar 

  24. Lord RVN, Ling JJ, Hugh TB, Coleman MJ, Doust BD, Nivison-Smith I (1998) Incidence of deep vein thrombosis after laparoscopic vs minilaparotomy cholecystectomy.Arch Surg 133: 967–973.

    CAS  Google Scholar 

  25. Okuda Y, Kitajima T, Egawa H, Hamaguchi S, Yamaguchi S, Yamazaki H, Ido K(2002) A combination of heparin and an intermittent pneumatic compression device may be more effective to prevent deep-vein thrombosis in the lower extremities after laparoscopic cholecystectomy. Surg Endosc 16: 781–784.

    Article  PubMed  CAS  Google Scholar 

  26. Morris JR, Woodcock PJ. (2004) Evidence-Based Compression. Prevention of Stasis and Deep Vein Thrombosis. Ann Surg. 239(2): 162–171.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. General Hospital Of Lamia, Lamia, Greece

    S. Letsos & O. Legga

  2. Surgical Department, University Of Athens, Laiko Hospital, Athens, Greece

    T. Diamantis, A. Giannopoulos, E. Bastounis & C. Tsigris

Authors
  1. S. Letsos
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  2. T. Diamantis
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  3. O. Legga
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  4. A. Giannopoulos
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  5. E. Bastounis
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  6. C. Tsigris
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Correspondence to S. Letsos.

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Letsos, S., Diamantis, T., Legga, O. et al. Influence of patient positioning and pneumoperitoneum on lower limbs venous haemodynamics during laparoscopic cholecystectomy. Hellenic J Surg 85, 78–84 (2013). https://doi.org/10.1007/s13126-013-0014-8

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  • DOI: https://doi.org/10.1007/s13126-013-0014-8

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