Venous haemodynamics during laparoscopic surgery: A cause for concern

Abstract

Summary. During laparoscopic surgery, intra-abdominal pressure is increased by the pneumoperitoneum. This may impede venous return from the legs and so predispose to venous thrombosis. The aim of this study was to investigate femoral venous velocity and femoral venous diameter during pneumoperitoneum, and to assess the reversibility of this effect by use of an intermittent calf compression device. Fourteen patients undergoing laparoscopic cholecystectomy were studied. A duplex scanner was used to assess femoral venous velocity (both with and without use of a calf compression device), and diameter, before, during and after establishment of a pneumoperitoneum. There was a significant reduction in the femoral venous velocity (from 0.15-0.105 m/s, P<0.01) and a significant increase in femoral venous diameter (from 6.55-9.3 mm, P<0.01) during pneumoperitoneum. The use of a calf compression device reversed this effect (augmented velocity of 0.395 m/s during pneumoperitoneum, P<0.01). These results indicate that laparoscopic surgery affects venous haemodynamics and this effect can be reversed with calf compression devices.