Decreased Porcine Uterine Blood Flow During Laparoscopic Nissen Fundoplication

Abstract

Background: Laparoscopy produces significant hemodynamic alterations that could affect blood flow through various systems, such as the cerebral, splanchnic, and renal circulations. While laparoscopic surgery is indicated for obstetrical and non-obstetrical conditions in pregnant patients, the effect of laparoscopy on uterine blood flow has hitherto been unclear. This experiment measures uterine blood flow in pigs undergoing laparoscopic Nissen fundoplication using radioactive microspheres. Methods: Six (6) pigs were subjected to a standard laparoscopic Nissen fundoplication. Microspheres (15 µm) labeled with five different radioisotopes were injected directly into the left ventricle at five different stages of the procedure. After the procedure, the pigs were euthanized and the uterus of the pig was harvested to measure blood flow. Results: There was a decrease in uterine blood flow at all stages of the procedure, with a statistically significant maximal drop in blood flow of –82%. These changes were associated with a simultaneous increase in paCO2 in all stages from baseline excepting the last time-point. Conclusions: Laparoscopy produces significant alterations in uterine blood flow. These changes can have profound effects on the fetus and maternal wellbeing by possibly worsening fetal acidosis. (J GYNECOL SURG 20:113)