Abstract
This study compared the effects of open versus laparoscopic radical hysterectomy on intraoperative diaphragmatic excursion and lung compliance. We enrolled 20 women per group; Group O’s members underwent open radical hysterectomy, while Group L’s members underwent laparoscopic radical hysterectomy. Diaphragmatic excursion was measured by assessing tidal ventilation using M-mode ultrasonography before intubation (T0), after intubation with mechanical ventilation (T1), 90 min after incision (T2), and at the end of the operation with recovery of muscle relaxation (T3). Peak inspiratory pressure and static lung compliance were measured using an anaesthesia machine combined with a ventilator. Diaphragmatic excursion was significantly lower in Group L than in Group O at T2 (5.3 ± 1.7 mm vs. 7.7 ± 2.0 mm, P < 0.001) and T3 (8.4 ± 1.9 vs. 10.4 ± 2.4, P = 0.011). Impaired diaphragmatic excursion at T3 (< 10 mm under mechanical ventilation) occurred in 15 patients (83.3%) in Group L and seven (38.9%) in Group O (P = 0.006). Changes over time in peak inspiratory pressure and static lung compliance differed significantly between the two groups (P < 0.001 each). Laparoscopic radical hysterectomy decreased diaphragmatic excursion and static lung compliance significantly more than open radical hysterectomy.Korean clinical trial number: Korean Clinical Trials Registry (KCT0004477) (Date of registration: November 18 2019) (https://cris.nih.go.kr/cris/search/search_result_st01_en.jsp?seq=14963<ype=&rtype=).
Highlights
This study compared the effects of open versus laparoscopic radical hysterectomy on intraoperative diaphragmatic excursion and lung compliance
Impaired diaphragmatic excursion at T3, defined as diaphragmatic excursion < 10 mm under mechanical ventilation, occurred in 15 (83.3%) patients who underwent laparoscopic radical hysterectomy and seven (38.9%) who underwent open radical hysterectomy (P = 0.006)
The present study showed that intraoperative diaphragmatic excursion and static lung compliance were reduced more in patients who underwent laparoscopic than in those who underwent open radical hysterectomy
Summary
This study compared the effects of open versus laparoscopic radical hysterectomy on intraoperative diaphragmatic excursion and lung compliance. Numerous reports have emphasised applying positive end-expiratory pressure (PEEP) and recruitment manoeuvres during laparoscopic surgery because of the Trendelenburg position and p neumoperitoneum[4,5,6,7,8]. This implies that the use of laparoscopic surgery cannot guarantee zero incidences of postoperative pulmonary complications. The present study compared the impact of the type of gynaecological surgery, open versus laparoscopic radical hysterectomy, on diaphragmatic excursion and lung compliance. Age (years) Body mass index (kg/m2) Hypertension Diabetes mellitus Other systemic diseases Hospital stay (days) Intraoperative data Operative time (min) Admitted crystalloid (ml)
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