Influence of pneumoperitoneum on the deep venous system during laparoscopy

Abstract

Background: 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.

Objective: To evaluate perioperative changes in the venous system and determine the frequency of deep venous thrombosis associated with minimally invasive surgery.

Design: Prospective consecutive series.

Subjects: Sixty-five patients undergoing elective minimally invasive surgery.

Intervention: Laparoscopic procedures with no thromboprophylaxis.

Results: 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).

Conclusion: 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.

Figure 1.

Significant decrease in femoral peak velocity at 12 mm Hg ( p < 0.05 ). (A) pressure at 10 mm Hg. (B) pressure at 12 mm Hg.

Figure 2.

Significant increase in femoral diameter at 12 mm Hg ( p < 0.05 ). (A) pressure at 0 mm Hg. (B) pressure at 12 mm Hg.