Overcoming reduced hepatic and renal perfusion caused by positive-pressure pneumoperitoneum

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. i 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/mm 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.