Effects of patient position on lower extremity venous pressure during different types of hysterectomy

Liu, Xiaoxia; Wang, Xiaohong; Meng, Xianhua; Wang, Hongping; An, Z S

doi:10.1111/jog.12489

Cited by 6 publications

(5 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Clinical studies have reported a significant increase in the venous pressure of the great saphenous vein in the lithotomy position compared with the supine position. 25 The lithotomy position with support behind the calf or knee increases ICP within the tibialis anterior muscle compartment to 16.5 versus 10.7 mmHg in the supine position. 26 Initially, venous drainage is impeded, but arterial supply is compromised eventually.…”

Section: Discussionmentioning

confidence: 99%

Male sex, height, weight, and body mass index can increase external pressure to calf region using knee-crutch-type leg holder system in lithotomy position

Mizuno¹,

Takahashi²

2016

TCRM

View full text Add to dashboard Cite

BackgroundWell-leg compartment syndrome (WLCS) is one of the catastrophic complications related to prolonged surgical procedures performed in the lithotomy position, using a knee-crutch-type leg holder (KCLH) system, to support the popliteal fossae and calf regions. Obesity has been implicated as a risk factor in the lithotomy position-related WLCS during surgery. In the present study, we investigated the relationship between the external pressure (EP) applied to the calf region using a KCLH system in the lithotomy position and selected physical characteristics.MethodsTwenty-one young, healthy volunteers (21.4±0.5 years of age, eleven males and ten females) participated in this study. The KCLH system used was Knee Crutch®. We assessed four types of EPs applied to the calf region: box pressure, peak box pressure, contact pressure, and peak contact pressure, using pressure-distribution measurement system (BIG-MAT®). Relationships between these four EPs to the calf regions of both lower legs and a series of physical characteristics (sex, height, weight, and body mass index [BMI]) were analyzed.ResultsAll four EPs applied to the bilateral calf regions were higher in males than in females. For all subjects, significant positive correlations were observed between all four EPs and height, weight, and BMI.ConclusionEP applied to the calf region is higher in males than in females when the subject is supported by a KCLH system in the lithotomy position. In addition, EP increases with the increase in height, weight, and BMI. Therefore, male sex, height, weight, and BMI may contribute to the risk of inducing WLCS.

show abstract

Section: Discussionmentioning

confidence: 99%

Male sex, height, weight, and body mass index can increase external pressure to calf region using knee-crutch-type leg holder system in lithotomy position

Mizuno¹,

Takahashi²

2016

TCRM

View full text Add to dashboard Cite

show abstract

“…Surprisingly the only episode of deep venous thrombosis (DVT) was recorded in the LRH cohort. Despite the lower risk of DVT's associated with laparoscopic surgery [10], the increased lower extremity venous pressure during prolonged Trendelenburg lithotomy positioning along with the CO 2 pneumoperitoneum can increase this risk [11]. The length of hospital stay for both LRH and ARH in this study was lower than the one quoted in reported studies but the reattendance rate was also high.…”

Section: Discussionmentioning

confidence: 67%

Safety and Cost Considerations during the Introduction Period of Laparoscopic Radical Hysterectomy

Anagnostopoulos

Decruze

Macdonald

et al. 2017

Obstetrics and Gynecology International

View full text Add to dashboard Cite

Objective. To compare the safety, efficacy, and direct cost during the introduction of laparoscopic radical hysterectomy within an enhanced recovery pathway. Methods. A 1 : 1 single centre retrospective case control study of 36 propensity matched pairs of patients receiving open or laparoscopic surgery for early cervical cancer. Results. There were no significant differences in the baseline characteristics of the two cohorts. Open surgery cohort had significantly higher intraoperative blood loss (189 versus 934 mL) and longer postoperative hospital stay (2.3 versus 4.1 days). Although no significant difference in the intraoperative or postoperative complications was found more urinary tract injuries were recorded in the laparoscopic cohort. Laparoscopic surgery had significantly longer duration (206 versus 159 minutes), lower lymph node harvest (12.6 versus 16.9), and slower bladder function recovery. The median direct hospital cost was £4850 for laparoscopic radical hysterectomy and £4400 for open surgery. Conclusions. Laparoscopic radical hysterectomy can be safely introduced in an enhanced recovery environment without significant increase in perioperative morbidity. The 10% higher direct hospital cost is not statistically significant and is expected to even out when indirect costs are included.

show abstract

“…The pneumoperitoneum pressure of gynecological laparoscopy is usually 12 to 15 mm Hg, while the normal pressure of human inferior vena cava is 2 to 5 mm Hg, which means that the greater the abdominal cavity pressure is, the greater the pressure of inferior vena cava will be, leading to slower blood flow. [ 21 , 22 ] At the same time, the blood is hypercoagulable, which is easy to cause endothelial damage and induce platelet activation, adhesion and release, thus increasing the risk of DVT occurrence.…”

Section: Discussionmentioning

confidence: 99%

Machine learning-based model for prediction of deep vein thrombosis after gynecological laparoscopy: A retrospective cohort study

Chen,

Hou,

Wang

2024

Medicine

View full text Add to dashboard Cite

Successful monitoring of deep vein thrombosis (DVT) remains a challenging problem after gynecological laparoscopy. Thus, this study aimed to create and validate predictive models for DVT with the help of machine learning (ML) algorithms. A total of 489 patients from the Cancer Biology Research Center, Tongji Hospital were included in the study between January 2017 and February 2023, and 35 clinical indicators from electronic health records (EHRs) were collected within 24h of patient admission. Risk factors were identified using the least absolute shrinkage and selection operator (LASSO) regression. Then, the three commonly used DVT prediction models are random forest model (RFM), generalized linear regression model (GLRM), and artificial neural network model (ANNM). In addition, the predictive performance of various prediction models (i.e. the robustness and accuracy of predictions) is evaluated through the receiver operating characteristic curve (ROC) and decision curve analysis (DCA), respectively. We found postoperative DVT in 41 (8.38%) patients. Based on the ML algorithm, a total of 13 types of clinical data were preliminarily screened as candidate variables for DVT prediction models. Among these, age, body mass index (BMI), operation time, intraoperative pneumoperitoneum pressure (IPP), diabetes, complication and D-Dimer independent risk factors for postoperative DVT and can be used as variables in ML prediction models. The RFM algorithm can achieve the optimal DVT prediction performance, with AUC values of 0.851 (95% CI: 0.793–0.909) and 0.862 (95% CI: 0.804–0.920) in the training and validation sets, respectively. The AUC values of the other two prediction models (ANNM and GLRM) range from 0.697 (95% CI: 0.639–0.755) and 0.813 (95% CI: 0.651–0.767). In summary, we explored the potential risk of DVT after gynecological laparoscopy, which helps clinicians identify high-risk patients before gynecological laparoscopy and make nursing interventions. However, external validation will be needed in the future.

show abstract

Effects of patient position on lower extremity venous pressure during different types of hysterectomy

Cited by 6 publications

References 19 publications

Male sex, height, weight, and body mass index can increase external pressure to calf region using knee-crutch-type leg holder system in lithotomy position

Male sex, height, weight, and body mass index can increase external pressure to calf region using knee-crutch-type leg holder system in lithotomy position

Safety and Cost Considerations during the Introduction Period of Laparoscopic Radical Hysterectomy

Machine learning-based model for prediction of deep vein thrombosis after gynecological laparoscopy: A retrospective cohort study

Contact Info

Product

Resources

About