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

Abstract

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). 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. 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. 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.