Abstract
Major laparoscopic pelvic surgery requires steep Trendelenburg position with pneumoperitoneum for a long time. We investigated the effect of Trendelenburg position with pneumoperitoneum on diaphragmatic excursion and lung compliance during major laparoscopic pelvic surgery using M-mode sonography. Twenty patients undergoing elective pelviscopic radical hysterectomy were included in this study. Diaphragmatic excursion was measured at the following time points; after sedation, after intubation, 90 minutes after Trendelenburg position with pneumoperitoneum, and after operation with recovery of muscle relaxation. And lung compliance was measured using anesthetic machine under general anesthesia; after the intubation, 90 minutes after Trendelenburg position with pneumoperitoneum and after operation with recovery of muscle relaxation. In order to detect postoperative pulmonary complication, postoperative chest radiography was checked. Static lung compliance, dynamic lung compliance and diaphragmatic excursion were decreased during operation (P < 0.001, respectively). At the end of the operation with recovery of muscle relaxation, reduced diaphragmatic movement was not recovered as its excursion after sedation (P < 0.001). In conclusion, lung compliance was decreased following transiently decreased diaphragmatic excursion during major laparoscopic pelvic surgery.
Highlights
In recent years, laparoscopic surgery has been preferred to open techniques because it results in less incisional pain, fewer pulmonary complications, and shorter hospital stays [1, 2]
Postoperative abnormal Chest X-ray (CXR) findings were presented in 7 patients, and there were no complaints of respiratory discomfort or pneumonia
In agreement with previous studies, our study revealed that major laparoscopic pelvic surgery decreased lung volume due to cephalic displacement of the diaphragm, and decreased diaphragmatic movement
Summary
Laparoscopic surgery has been preferred to open techniques because it results in less incisional pain, fewer pulmonary complications, and shorter hospital stays [1, 2]. Pneumoperitoneum decreases pulmonary compliance due to cephalad displacement of the diaphragm [3]. Cephalad displacement of the diaphragm can incur intraoperative lung volume changes, leading to the possibility of atelectasis formation [4]. Diaphragmatic movement may decrease after maintaining the steep Trendelenburg position with pneumoperitoneum for a long time. Previous studies reported that impaired diaphragmatic function after abdominal surgery is a determining factor in the pathogenesis of postoperative.
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