Schwenk W, Haase O, Junghans T.
Perspective in sequential pneumatic compression of the lower extremities (SCD)
for laparoscopic surgery.
Acta Chir Belg 2002 Apr;102(2):83-91

Department of General-, Visceral-, Vascular- and Thoracic Surgery, Medical
Faculty of the Humboldt-University, Berlin. wolfgang.schwenk@charite.de

During most cases of laparoscopic surgery, a pneumoperitoneum of 12-14 mm Hg CO2
is established. Although not always detected in healthy patients, a
pneumoperitoneum will cause clinically relevant pathophysiological changes. Among
other side effects, a pneumoperitoneum will alter the venous blood return from
the lower extremities and depress cardiac function. Results from experimental and
clinical studies concerning the influence of a pneumoperitoneum on venous blood
return and cardiac function are reviewed and a simple model of cardiac function
impairment during laparoscopic surgery with a pneumoperitoneum is presented.
Sequential pneumatic compression of the lower extremities is effective in
reducing venous stasis during and after conventional surgery. Several clinical
trials determined the hemodynamic effect of intraoperative SCD (sequential
compression device) during laparoscopic surgery. In the following text the
results of these studies are summarized and possible implications for the
clinical use of SCD in laparoscopic surgery are discussed. Although potential
benefits of SCD-therapy have been shown only in studies of low methodological
quality, intraoperative SCD-therapy is recommended during prolonged laparoscopic
surgery.