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Amitai Bickel, MD; Norman Loberant, MD; Marina Bersudsky, MD; Moshe Goldfeld, MD; Shimon Ivry, MD; Miryam Herskovits, MD; Arie Eitan, MD

Arch Surg. 2007;142(2):119-124.

Hypothesis  Use of the intermittent sequential pneumatic compression (ISPC) device may improve splanchnic and renal perfusion caused by positive-pressure pneumoperitoneum (PPP) in patients undergoing laparoscopic cholecystectomy.

Design  Prospective controlled study.

Setting  University hospital.

Patients  Twenty-two consecutive patients undergoing elective laparoscopic cholecystectomy whose cardiac output decreased at least 10% on induction of PPP.

Intervention  The ISPC device was activated over the lower limbs 15 minutes after PPP was established for the remainder of surgery.

Main Outcome Measures  Urine output, cardiovascular functions, and hepatic and renal perfusion were measured during the surgical phases; urine output was quantified in a matched control group (n = 30).

Results  Induction of PPP significantly decreased cardiac output and stroke volume, while ISPC significantly reversed these changes. Increased systemic vascular resistance during PPP was reversed by ISPC. Activation of the pneumatic sleeves during PPP increased the mean ± SD portal venous and hepatic arterial blood flows from 0.86 ± 0.30 to 1.33 ± 0.44 L/min (P<.001) and from 0.26 ± 0.10 to 0.38 ± 0.19 L/min (P = .002), respectively; the mean renal segmental arterial index decreased with ISPC from 0.68 ± 0.05 to 0.63 ± 0.08 (P = .003). During PPP, urine output decreased from 1.10 to 0.28 mL/min per meter squared (P = .001) but improved markedly with ISPC to 0.61 mL/min per meter squared (P = .01). Such improvement was absent in the control group.

Conclusions  Use of ISPC significantly improves hepatic and renal blood flows during PPP. Its application is recommended during prolonged laparoscopic procedures, including laparoscopic live donor nephrectomy.

Author Affiliations: Departments of Surgery (Drs Bickel and Eitan), Radiology (Drs Loberant, Goldfeld, and Herskovits), and Anesthesiology (Drs Bersudsky and Ivry), Western Galilee Hospital, Nahariya, and The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa (Drs Bickel, Loberant, and Eitan), Israel.

RELATED LETTERS

Reduced Renal and Hepatic Perfusion Caused by Pos-itive-Pressure Pneumoperitoneum: Impact on Donor Kidneys
Mahesh Goel
Arch Surg. 2007;142(12):1225.
EXTRACT | FULL TEXT  

Reduced Renal and Hepatic Perfusion Caused by Pos-itive-Pressure Pneumoperitoneum: Impact on Donor Kidneys—Reply
Amitai Bickel, Norman Loberant, and Arie Eitan
Arch Surg. 2007;142(12):1225-1226.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Overcoming Reduced Hepatic and Renal Perfusion Caused by Positive-Pressure Pneumoperitoneum—Invited Critique
Robert A. Kozol
Arch Surg. 2007;142(2):125.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Reduced Renal and Hepatic Perfusion Caused by Pos-itive-Pressure Pneumoperitoneum: Impact on Donor Kidneys
Goel
Arch Surg 2007;142:1225-1225.
FULL TEXT  

Reduced Renal and Hepatic Perfusion Caused by Pos-itive-Pressure Pneumoperitoneum: Impact on Donor Kidneys Reply
Bickel et al.
Arch Surg 2007;142:1225-1226.
FULL TEXT