Femoral venous flow during laparoscopic gynecologic surgery

The lower-limb venous return, assessed by the peal; systolic venous velocit ies (PSVV) of the left common femoral vein, was recorded at different stage s of operation for five patients undergoing major gynecologic operative lap aroscopy. The average baseline PSVV was 23.1 cm/s. After positioning the pa tient in the Trendelenburg position, the PSVV increased to an average of 31 .5 cm/s; this was a statistically significant increase. Creation of the pne umoperitoneum changed the waveform from a normal phasic pattern to a dampen ed, continuous, monophasic waveform. The average PSVV was reduced to 15.9 c m/s; this dampening was statistically significant. Further dampening was ev ident 1 hour intraoperatively, and the now became intermittent, with cycles of dampened flow followed by periods of absent Row; these changes in PSVV were not statistically significant. Calf compressors did not increase the f emoral PSVV at the beginning of operation, nor at 1 hour intraoperatively; the decrease was not statistically significant. After release of the pneumo peritoneum, the baseline waveform pattern and velocity returned. The Trende lenburg position used for gynecologic operative laparoscopy was associated with a statistically significant increase in the lower-limb PSVV. This incr ease did not fully counteract the dampening effect of a pneumoperitoneum on lower-limb PSVV. The authors' study did not support the benefit previously reported on the use of pneumatic calf compressors. The authors therefore r ecommend continuing the practice of antithrombotic measures for patients un dergoing gynecologic operative laparoscopy.