Lower limb venous hemodynamics during laparoscopy: an animal study

Area of Science:

• Surgical Procedures
• Physiology
• Vascular Medicine

Background:

• Laparoscopic surgery involves insufflating the abdomen, increasing intra-abdominal pressure.
• Venous return is crucial for maintaining adequate circulation.
• Potential risks like deep venous thrombosis (DVT) and pulmonary embolism (PE) are concerns in prolonged laparoscopic procedures.

Purpose of the Study:

• To investigate the impact of elevated intra-abdominal pressure (IAP) on femoral venous blood outflow.
• To evaluate the combined effect of IAP and reverse Trendelenburg position on venous return.
• To assess venous blood flow adaptation during extended laparoscopic surgery.

Main Methods:

• Utilized a porcine animal model to simulate laparoscopic conditions.
• Progressively increased intra-abdominal insufflation pressure and measured femoral venous blood outflow.
• Assessed the influence of the reverse Trendelenburg position on venous flow.
• Monitored venous flow during a prolonged laparoscopic Nissen fundoplication.

Main Results:

• Femoral venous blood outflow was significantly reduced at insufflation pressures of 10-20 mm Hg.
• The reverse Trendelenburg position exacerbated the reduction in venous blood flow.
• No evidence of adaptation in venous blood flow was observed during the prolonged surgical procedure.

Conclusions:

• Elevated intra-abdominal pressure during laparoscopy markedly impairs venous return.
• The combination of increased IAP and reverse Trendelenburg position poses a significant risk.
• Findings suggest an increased potential for DVT/PE following prolonged laparoscopic interventions.