Influence of patient positioning and pneumoperitoneum on lower limbs venous haemodynamics during laparoscopic cholecyste
- PDF / 357,282 Bytes
- 7 Pages / 595.22 x 842 pts (A4) Page_size
- 30 Downloads / 214 Views
Influence of Patient Positioning and Pneumoperitoneum on Lower Limbs Venous Haemodynamics During Laparoscopic Cholecystectomy Clinical Study S. Letsos, T. Diamantis, O. Legga, Α. Giannopoulos, Ε. Bastounis, C. Tsigris Received 24/11/2012 Accepted 15/12/2012
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.
S. Letsos (Corresponding author) O. Legga - General Hospital Of Lamia T. Diamantis, Α. Giannopoulos, Ε. Bastounis, C. Tsigris - First Surgical Department University Of Athens, Laiko Hospital, Greece e-mail: [email protected]
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.
Key words:
Lower limbs venous haemodynamics, Laparoscopic cholecystectomy, Patient positioning, Pneumoperitoneum, Plethysmography.
Introduction The applications of laparoscopic surgery have grown tremendously over the last decade. Advancements have resulted in decreased length of hospitalization with early postoperative mobility (and consequent lower cost), reduced postoperative pain and improved aesthetic results [1-2] following general surgical procedures. The introduction of laparoscopic surgery has dramatically changed the management of gallstone disease, establishing laparoscopic cholecystectomy (LC) as the method of choice for treating cholelith
Data Loading...
