lithotomy-Trendelenburg Position Research Articles

Upper extremity contact pressure measurement in robot-assisted pelvic surgery

Upper extremity complications are often a problem in robot-assisted pelvic surgery (RAPS) with the lithotomy-Trendelenburg position (LT-position). This study focused on upper extremity contact pressure (UEP) and examined the relationship between UEP and upper extremity complications. From May 2020 to April 2022 at the University of Tokyo Hospital, UEP was measured in 155 patients undergoing RARP and 20 patients undergoing RARC. A total of 350 sets of UEP were investigated in this study. UEP was measured using a portable interface pressure sensor (Palm Q, Cape CO., Kanagawa, Japan) in the preoperative lithotripsy position (L-position), preoperative LT-position, and postoperative L-position. UEP was increased in the preoperative LT-position than in the preoperative L-position (right side 5.2 mmHg vs. 17.1 mmHg, left side 5.3 mmHg vs. 17.1 mmHg, P < 0.001, respectively), and was decreased in the postoperative L-position than in preoperative LT-position (right side 17.1 mmHg vs. 10.8 mmHg, left side 17.1 mmHg vs. 10.6 mmHg, P < 0.001, respectively). Eleven upper extremities developed shoulder pain. UEP of the preoperative LT-position tended to be higher in the upper extremity exhibiting shoulder pain (25.6 mmHg (15.4–30.3) vs. 17.1 mmHg (12.0–24.4) P = 0.0901). UEP measurements may help prevent postoperative shoulder pain.

8849 Niamh Joyce MD, OBSTETRICS AND GYNECOLOGY, MRCOG, Fellow in Reproductive Medicine

<h3>Study Objective</h3> Video demonstration of fertility sparing laparoscopic treatment for a symptomatic Müllerian Tract abnormality <h3>Design</h3> Single Case Report. <h3>Setting</h3> Tertiary Academic Hospital. 3 port laparoscopy, with patient in Trendelenburg Lithotomy position <h3>Patients or Participants</h3> A 16-year-old nulliparous patient presented with intractable dysmenorrhea since menarche aged 15, associated with syncope. There was no response to analgesia or hormonal contraception and the impact on quality-of-life necessitated surgical review. Initial assessment by pelvic ultrasound identified normal ovaries and uterus but a solid appearing right adnexal lesion. Further imaging by MRI showed evidence of a double uterus with only the left sided uterus communicating with the vagina in keeping with an ASRM class II(b) abnormality. Differential diagnosis included Mullerian duct abnormality and accessory and cavitated mass. A uterine didelphys with only a left ostia was seen on hysteroscopy. Laparoscopy showed a uterine didelphys with a non-communicating, engorged right uterus and right fallopian tube. Her case was discussed at a multidisciplinary meeting where it was decided the most suitable treatment was to perform a laparoscopic hemi-hysterectomy with right salpingectomy to remove the right sided non communicating cavity and tube. This procedure was recorded with the patient's consent and will be shown as part of the video presentation. <h3>Interventions</h3> Laparoscopic hemi-hysterectomy for resection of non-communicating uterine horn. EBL minimal. Operative time 37 Mins, hospital stay 1 night. <h3>Measurements and Main Results</h3> A successful laparoscopic intervention was performed, and the patient was discharged day 1 post op. Review at clinic revealed completed resolution of symptoms, normal menses. Future fertility was a primary concern and was successfully conserved. Histology demonstrated a functioning endometrial cavity with focal adenomyosis. <h3>Conclusion</h3> Class II Müllerian abnormalities are uncommon, affecting around 0.06% of females. Symptoms can include pain or menstrual dysfunction as well as fertility/obstetric complications. When necessary, a minimally invasive approach can be utilized to treat these conditions.

Trendelenburg Lithotomy Position During Vaginoscopic Office Hysteroscopy Reduces Pain and Procedure Duration

Trendelenburg Lithotomy Position During Vaginoscopic Office Hysteroscopy Reduces Pain and Procedure Duration

Laparoscopic Sacrocervicopexy for Uterovaginal Prolapse: Step by Step for Safety and Efficiency

<h3>Study Objective</h3> The purpose of this video is to demonstrate the step by step of laparoscopic sacrocervicopexy for uterovaginal prolapse using a Y-shaped monofilament polypropylene mesh. <h3>Design</h3> Laparoscopic Subtotal hysterectomy is performed. After that, opening of the posterior peritoneum took place on the sacral promontory and was extended under the right uterosacral ligament. The Douglas pouch was then opened, and the rectovaginal plane was exposed. This maneuver was facilitated by the introduction and the relevant movements of a vaginal malleable valve. Dissecting the inter vesicovaginal space, the anterior mesh is on the anterior vaginal apex with two other sutures and the anterior mesh was fixed on the anterior vaginal wall just before the trigone and at the isthmus of the uterus. After that, the posterior mesh was fixed on the posterior vaginal apex with two other sutures and on the posterior vaginal wall. Both sutures with a 2/0 polygalactin suture. Mesh were anchored on the sacral promontory using a 0 polypropylene non absorbable suture on the longitudinal ligament. At the end, full peritonization of the mesh with a 2–0 polyglactin running suture. <h3>Setting</h3> Patient positioned in a Trendelenburg lithotomy position with legs slightly bent. A 10-mm trocar was placed at the umbilicus, two 5-mm trocars were positioned 2 cm above and medially to the anterior superior iliac spine and a third was positioned midway between the umbilicus and the pubic symphysis. <h3>Patients or Participants</h3> One 56 years old female patient with uterovaginal prolapse stage IV. <h3>Interventions</h3> laparoscopic sacrocervicopexy for uterovaginal prolapse with Y-shaped monofilament macroporous polypropylene mesh. <h3>Measurements and Main Results</h3> The laparoscopic sacrocervicopexy can be performed in patient at stage IV uterovaginal prolapse after partial hysterectomy in an efficient way. After the laparoscopic sacrocervicopexy surgery, the patient evolved with correction of the prolapse to stage I. <h3>Conclusion</h3> Laparoscopic surgery allows a good view of the vaginal walls performing this procedure safely and efficiently

Robotic Low Anterior Resection and Partial Bladder Resection for Management of Locoregional Endometrial Cancer Recurrence

To demonstrate a robotic tumor debulking for management of locoregional endometrial cancer recurrence. Case report. Tertiary referral center in New Haven, CT. A 70-year-old patient with a history of stage IB endometrioid endometrial cancer presented with rectal bleeding 3 years after the completion of treatment. A mass involving the distal sigmoid colon/upper rectum and bilateral distal periureteral masses were visualized on imaging. There was no distant metastatic disease. Colonoscopic biopsies were consistent with endometrial cancer recurrence. Because the patient was symptomatic with rectal bleeding and had no distant metastasis, it was recommended that she undergo surgical resection for management of this locoregional recurrence. The patient was placed in reverse Trendelenburg position with a rightward tilt to mobilize the splenic flexure. Once the cephalad aspect of the descending colon mobilization was completed, the patient was placed in Trendelenburg lithotomy position to expose the pelvis. A robot was docked at this point and the pelvic avascular spaces were delineated. A medial-to-lateral approach was used in mobilization of the sigmoid colon mesentery. The left ureter was identified and the sigmoid branches of inferior mesenteric artery were sealed. The descending/sigmoid colon junction was stapled. After complete mobilization of the sigmoid colon, the tumor-free upper rectum was delineated and stapled. Attention was then turned to the distal peri-ureteral masses. The 2-cm mass on the right, which was densely adherent to the distal right ureter, was completely resected after extensive ureterolysis. The resection of the 4-cm mass on the left which involved both the distal left ureter and the bladder dome required an intentional cystotomy and a partial cystectomy to attain negative margins (Supplemental Figure 1). The procedure was continued with the bowel anastomosis. The anvil was introduced through the vagina and was placed into the proximal limb through an antimesenteric incision. An end-to-end tension-free anastomosis was performed and adequate vascularization was confirmed with intravenous indocyanine green. Robotic low anterior resection and partial bladder resection were performed without any complications with negative margins. Robotic tumor debulking should be considered in appropriate patients when managing locoregional recurrence of endometrial cancer [1,2].

1896 Primary Solitary Anterior Abdominal Wall Leiomyoma

Study Objective To present a case of primary solitary large anterior abdominal wall leiomyoma Design Leiomyomas are said to be the most common benign tumor of the female reproductive tract. They are frequently found in the uterus, however they can also be found in the broad ligament, ovaries, fallopian tubes, vagina and, very rarely, on the abdominal wall. Abdominal wall leiomyomas are rare and usually thought to be associated with previous surgical resection of uterine myomas. Setting The patient was placed in lithotomy Trendelenburg position and under general anesthesia. Patients or Participants N/A Interventions Robotic-assisted mass excision was performed, and the specimen was carefully removed from a mini-laparotomic incision. Measurements and Main Results A 42 year-old woman, with no history of prior uterine surgeries, presented with a lump in the right lower abdomen which had been progressively increasing in size for months. Ultrasound revealed an anterior abdominal mass, with a diameter of about 9 cm, with no evidence of uterine myomas or ovarian tumors. To exclude the possibility of malignancy, the patient underwent robotic-assisted mass excision. Histopathology of the anterior wall mass showed a leiomyoma with diffuse coagulation tissues (weighted at 213 g). Conclusion Abdominal wall leiomyoma is an uncommon finding and is thought to be related to seeding following uterine myomectomies; however, the patient in this case had never undergone any uterine surgeries. The precise cause of the origin of primary abdominal wall leiomyoma is not clear at present. Transformation of the smooth muscle cell of the vessel wall in the anterior abdominal layer to leiomyoma may play a role. It is hypothesized to be associated with somatic mutation or interaction of hormonal and growth factors. In conclusion, benign primary leiomyoma of the abdominal wall is a differential diagnosis to be considered in women with an anterior abdominal mass and no histories previous uterine surgeries.

RETRACTED ARTICLE: The effects of a recruitment manoeuvre with positive end-expiratory pressure on lung compliance in patients undergoing robot-assisted laparoscopic radical prostatectomy

The effects of a recruitment manoeuvre (RM) with positive end-expiratory pressure (PEEP) on lung compliance (CLUNG) are not well characterised in robot-assisted laparoscopic radical prostatectomy (RARP). Patients were allocated to group R (n = 10; with an RM) or C (n = 9; without an RM). An RM involved sustained inflation of 30 cmH2O for 30 s. The lungs were ventilated with volume-controlled ventilation with tidal volume of 7 mL kg−1 of predicted body weight and fraction of inspired oxygen of 0.5. End-tidal carbon dioxide pressure was maintained at normocapnia. Patients were in the horizontal lithotomy position (pre-op). After pneumoperitoneum, patients underwent RARP in a steep Trendelenburg lithotomy position at a PEEP level of 0 cmH2O (RARP0). An RM was used in the R group but not in the C group. Patients were then ventilated with 5 cmH2O PEEP for 1 h after RARP0 (RARP5.1) and 2 h after RARP0 (RARP5.2). Oesophageal pressure and airway pressure were measured for calculating CLUNG and chest wall compliance. CLUNG significantly decreased from pre-op to RARP0 and did not significantly increase from RARP0 to RARP5.1 and RARP5.2 in either group. CLUNG differed significantly between groups at RARP5.1 and RARP5.2 (103 ± 30 vs. 68 ± 11 mL cm−1 H2O and 106 ± 35 vs. 72 ± 9 mL cm−1 H2O; P < 0.05). In patients undergoing RARP, with the addition of RM, the CLUNG was effectively increased from the horizontal lithotomy position to the steep Trendelenburg lithotomy position under pneumoperitoneum.

Measuring Contact Pressure of Lower Extremities in Patients Undergoing Robot-Assisted Radical Prostatectomy

Introduction: Lower extremity neuropathy (LEN) is a well-recognized complication that arises during robotic surgeries in lithotomy-Trendelenburg position (L-T position). It is caused by persistent compression to the nerves. Our aim was to investigate the levels of compression to the nerves by measuring the contact pressure of the lower extremities in men undergoing robot-assisted radical prostatectomy (RARP). Materials and Methods: A total of 138 patients undergoing RARP were enrolled prospectively. The contact pressure of the lower extremities was measured using a portable contact pressure measurement device (Cello®, Cape Co., Kanagawa, Japan) in lithotomy position (L position) and L-T position preoperatively, and in L position postoperatively. Patient positioning was readjusted when the preoperative contact pressure was over 32 mm Hg. The contact pressure was compared between pre- and postoperative values. Results: A total of 33 patients (23.9%) needed readjustment of positioning due to high contact pressure. No one developed LEN. The contact pressure in the L position significantly increased postoperatively (right: 21.4 mm Hg, p < 0.0001; left: 18.6 mm Hg, p = 0.0011). A high body mass index (BMI) was associated with a postoperative increment of pressure in the L position. Conclusions: The contact pressure of the lower extremities increased after RARP and the increase was correlated with BMI.

Feasibility and short-outcomes of laparoscopic extralevator abdominoperineal excision without changing position for distal rectal cancer

To evaluate the short-term outcomes of laparoscopic extralevator abdominoperineal excision (ELAPE) without changing position during operation. Totally 51 patients with distal advanced rectal cancer received surgical operation in Peking Union Midical College Hospital from September 2011 to April 2014. There were 29 male and 22 female patients with a mean age of (61 ± 10) years. Twenty-six percent of the patients received preoperative concomitant chemotherapy and radiation. Twenty-seven patients underwent laparoscopic abdominoperineal excision (APE) procedure, while 24 patients underwent ELAPE procedure. In both groups, patients were kept Lithotomy-Trendelenburg position during operation. The fat tissue in ischialrectal fossa was not routinely removed, except the tumor invasion. All the patients' pelvic peritoneum was closed by continuous suturing, and subcutaneous tissue and skin by interrupted suturing. Retrospectively compare the pathoclinical features, operation time, bleeding, node retrieval, lateral margin and complications by t-text and χ(2) test respectively between ELAPE and APE procedures both by laparoscopic approach. No significant differences were found in term of age, gender, BMI, distance from anal verge, percentage of neoadjuvant chemoradiation, and TNM staging between these two groups (all P > 0.05). The operation time was significantly shorter in ELAPE group ((181 ± 41) minutes vs. (228 ± 58) minutes, t = -3.265, P = 0.002). The bleeding volume was less in ELAPEE group (50 (80) ml vs 80 (100) ml (M(QR)), Z = -2.259, P = 0.024). The lateral margin, urinal retention and perineal wound healing were comparable for these two groups. No pelvic hernia was found during the postoperative follow-up (2 to 34 months) in both groups (all P > 0.05). Laparoscopic extralevator abdominoperineal excision without changing position is feasible for distal rectal cancer. Some essential steps can be simultaneously accomplished during operation without changing position. Closing the pelvic peritoneum is important for preventing the intestine dropping from abdominal cavity to presacral cavity.

Laparoscopic Radical Hysterectomy

Under general anesthesia, the patient was put in a lithotomy-Trendelenburg position. A 10-mm trocar was introduced through the umbilicus, and the abdominal cavity was insufflated with carbon dioxide and explored for evidence of metastatic disease.One pair of 5-mm trocars was placed symmetrically approximately 4 cm away from the umbilicus, slightly below the horizontal line passing through the umbilicus. Another pair of trocars, one 5 mm and the other 10 mm, was inserted bilaterally at the outer one-third of the iliac spine umbilicus line symmetrically.

Comparison of respiratory mechanics between sevoflurane and propofol-remifentanil anesthesia for laparoscopic colectomy

BackgroundThe creation of pneumoperitoneum and Trendelenburg positioning during laparoscopic surgery are associated with respiratory changes. We aimed to compare respiratory mechanics while using intravenous propofol and remifentanil vs. sevoflurane during laparoscopic colectomy.MethodsSixty patients undergoing laparoscopic colectomy were randomly allocated to one of the two groups: group PR (propofol-remifentanil group; n = 30), and group S (sevoflurane group; n = 30). Peak inspiratory pressure (PIP), dynamic lung compliance (Cdyn), and respiratory resistance (Rrs) values at five different time points: 5 minutes after induction of anesthesia (supine position, T1), 3 minutes after pneumoperitoneum (lithotomy position, T2), 3 minutes after pneumoperitoneum while in the lithotomy-Trendelenburg position (T3), 30 minutes after pneumoperitoneum (T4), and 3 minutes after deflation of pneumoperitoneum (T5).ResultsIn both groups, there were significant increases in PIP and Rrs while Cdyn decreased at times T2, T3, and T4 compared to T1 (P < 0.001). The Rrs of group PR for T2, T3, and T4 were significantly higher than those measured in group S for the corresponding time points (P < 0.05).ConclusionsRespiratory mechanics can be adversely affected during laparoscopic colectomy. Respiratory resistance was significantly higher during propofol-remifentanil anesthesia than sevoflurane anesthesia.

Difficult diagnosis of malignant hyperthermia during laparoscopic surgery

Difficult diagnosis of malignant hyperthermia during laparoscopic surgery

Side-docking Technique for Robot-assisted Urologic Pelvic Surgery

To investigate the feasibility of side-docking techniques in robot-assisted urologic pelvic surgery. Six consecutive patients undergoing robot-assisted pelvic surgery participated in the study: 3 undergoing radical cystectomy for muscle-invasive bladder cancer, 1 patient undergoing ureteroneocystostomy for ureteric stricture, 1 patient undergoing partial cystectomy for urothelial cancer in a bladder diverticulum, and 1 undergoing transvesical simple prostatectomy. Each patient was placed in the lithotomy-Trendelenburg position, with the robot docked over the patient's right side. All the procedures were completed without the need for redocking. Simultaneous cystourethroscopy was performed in 1 case to localize a bladder diverticular tumor during a partial cystectomy. Manipulation of the uterus and perineum was possible by the second assistant sitting between the patients' legs. No significant collision between the robotic arms occurred. There was no Clavien-Dindo III-V complication in any case. Side docking for robot-assisted urologic pelvic surgery is a viable positioning alternative with the advantage of enhanced access to the perineum and urethra. This modified approach will be useful in robot-assisted radical cystectomy and other reconstructive urologic procedures.

Change of respiratory mechanics at different intra-abdominal pressures and position change during laparoscopic surgery

Change of respiratory mechanics at different intra-abdominal pressures and position change during laparoscopic surgery

Evaluation of Anti-Slide Methods To Avoid Patient Shifting during Trendelenburg Lithotomy Position for Minimally Invasive Gynecologic Surgery

Evaluation of Anti-Slide Methods To Avoid Patient Shifting during Trendelenburg Lithotomy Position for Minimally Invasive Gynecologic Surgery

The effect of pneumoperitoneum and Trendelenburg position on respiratory mechanics during pelviscopic surgery

BackgroundConventional pelviscopic surgery requires pneumoperitoneum with CO2 gas insufflation and lithotomy-Trendelenburg position. Pneumoperitoneum and Trendelenburg position may influence intraoperative respiratory mechanics in anesthetic management. This study was conducted to investigate the influence of pneumoperitoneum and Trendelenburg position on respiratory compliance and ventilation pressure.MethodsTwenty-five patients scheduled for elective gynecologic laparoscopy were evaluated. The patients had no preexisting lung or heart disease or pathologic lung function. Conventional general anesthesia with thiopental sodium, lidocaine, rocuronium, and sevoflurane was administered. The peak inspiratory pressure, plateau pressure, and end-tidal CO2 were measured before and after creation of pneumoperitoneum with an intraabdominal pressure of 12 mmHg, then after 10 minutes and 30 minutes in the 20° Trendelenburg position, and after deflation of pneumoperitoneum. The dynamic lung compliance was then calculated.ResultsFollowing creation of pneumoperitoneum, there was a significant increase in peak inspiratory pressure (6 cmH2O), plateau pressure (7 cmH2O), and end-tidal CO2 (5 mmHg), while dynamic lung compliance decreased by 12 ml/cmH2O. Overall, the Trendelenburg position induced no significant hemodynamic or pulmonary changes.ConclusionsThe effects of pneumoperitoneum significantly reduced dynamic lung compliance and increased peak inspiratory and plateau pressures. The Tredelenburg position did not change these parameters.

Effect of age on pulmonary gas exchange during laparoscopy in the Trendelenburg lithotomy position

Physiological changes in respiratory mechanics caused by aging may lead to a deterioration in pulmonary gas exchange, an increase in the alveolar-arterial oxygen gradient [(A-a)D(O2)] and a difference between the arterial carbon dioxide (CO(2)) tension (P(a)(CO(2))) and expired end-tidal CO(2) tension (P(ET)(CO(2))) [P((a-ET))(CO(2))] during laparoscopy in the Trendelenburg lithotomy position (TLP). The subjects were 51 gynecologic patients. Pressure-controlled ventilation was used to maintain P(ET)(CO(2)), measured by the side stream method, within the range 4-4.67 kPa. During laparoscopy with CO(2) insufflation in TLP, the tidal volume was increased to keep P(ET)(CO(2)) within +/- 20% of the pre-insufflation value. The subjects were divided into three groups by age: young group (< 45 years); middle-aged group (45-64 years); and elderly group ( > or = 65 years). Before pneumoperitoneum (PPN), significant differences were found between the young and elderly groups in the arterial oxygen tension (P(a)(O(2))), (A-a)D(O(2)), P(a)(CO(2)) and P((a-ET))(CO(2)). In all groups, the peak inspiratory pressure and P(a)(CO(2)) increased progressively during PPN in TLP. P((a-ET))(CO(2)) increased gradually after starting CO(2) insufflation in TLP only in the elderly group. An increase in P((a-ET))(CO(2)) was seen during PPN in TLP in the elderly group. With CO(2) insufflation in TLP, the setting of mechanical ventilation based on the value of P(ET)(CO(2)) (measured by the side stream method) should be determined with caution in elderly patients.

The Effect of Lithotomy-Trendelenburg Position and Carbon Dioxide Insufflation on the Distance from the Upper Incisor to the Carina

Background: The carbon dioxide () insufflation and lithotomy-Trendelenburg position are required in the laparoscopic gynecologic surgery. However, they can change the distance from the upper incisor to the carina. This may increase the risk of endobronchial intubation. Methods: Nineteen patients, aged 29-50 yr, who were undergoing laparoscopic surgery were enrolled. We measured the distance from the upper incisor to the carina of them with fiberoptic bronchoscope. Measurements were taken in the each point of lithotomy position, lithotomy-Trendelenburg position, and lithotomy-Trendelenburg position after insufflation. Results: The average distance from the upper incisor to the carina was 23.1 1.4 cm in the lithotomy position () and was significantly decreased to 22.6 1.4 cm in the lithotomy-Trendelenburg position () (P insufflation into the abdominal cavity, the mean distance in the lithotomy-Trendelenburg position () was significantly decreased to 22.11.4 cm (P insufflation decrease the distance from the upper incisor to the carina.

Hemodynamic Changes Measured by Esophageal Doppler Monitor during Laparoscopic Cholecystectomy and Gynecologic Pelviscopy

Background: Laparoscopic cholecystectomy and gynecologic pelviscopy need to induce pneumoperitoneum to allow visualization of the operative field, but the former requires a head-up position whereas the latter needs a Lithotomy-Trendelenburg position. The authors observed hemodynamic changes using an esophageal doppler monitor in both cases. Methods: Eight females planned for laparoscopic cholecystectomy were assigned to Group 1 and 10 females for gynecologic pelviscopy were assigned to Group 2. Thiopental (5 mg/kg) and vecuronium (0.1 mg/kg) were used to induce general anesthesia. 50% and 1.5 vol.% isoflurane were used to maintain anesthesia. Mechanical ventilation was used with a tidal volume of 10 ml/kg and a respiratory rate of 12 breaths per minute. Mean arterial pressure, heart rate, end-tidal and peak airway pressure were measured and cardiac output, corrected flow time, and peak velocity were monitored using an esophageal doppler monitor in each group after inducing anesthesia, inflation, position change, and deflation. Results: Mean arterial pressure increased in each group while changing position. No significant changes in the heart rate were observed in each group. End-tidal increased in each group after changing position, and remained elevated even with position reversal and deflation. Peak airway pressure was elevated in each group after inflation and increased more so with changing posture in group 2 (post inflation: 18.5 1.4 cm, after position change: 21.4 7 2.0 cm). Cardiac output and cardiac index were reduced after the induction of pneumoperitoneum in each group, and reduced more on changing posture in group 2 (CO: 5.9 2.0 L/min vs. 4.4 1.5 L/min, CI: 3.7 1.4 L/min/ vs. 2.7 1.1 L/min/). Stroke volume also reduced after changing posture in each group. Corrected flow time was not changed, but peak velocity decreased after inflation in each group (group 1: 97.4 30.0 cm/s vs. 78.9 27.3 cm/s, group 2: 111.9 14.1 cm/s vs. 88.3 12.6 cm/s). Conclusions: The Lithotomy-Trendelenburg position can augment the hemodynamic changes resulting from pneumoperitoneum. Therefore, additional caution is required in patients with cardiovascular disease who are undergoing gynecologic pelviscopy.

The Effect of the Lithotomy-Trendelenburg Position on Respiratory and Hemodynamic Changes during General Anesthesia

intraoperative hemodynamic and respiratory changes that complicate anesthetic management. This study was performed to evaluate the effects of the lithotomy-Trendelenburg position on respiratory and hemodynamic changes with time passage during general anesthesia. Methods: Twenty patients undergoing anorectal surgery with general anesthesia were studied. Hemodynamic and respiratory parameters were measured before the lithotomy-Trendelenburg position (L) and 3 min (LT3), 6 min (LT6), 12 min (LT12), 30 min (LT30) and 60 min (LT60) after the 30 degree Trendelenburg position. The cardiac index (CI), stroke volume (SV), systemic vascular resistance (SVR), airway resistance (Raw) and dynamic compliance (Cdyn) were measured by a non-invasive cardiac output monitor. Results: Central venous pressure and peak inspiratory pressure were markedly increased from the lithotomy to the lithotomy-Trendelenburg position. Heart rate was slightly increased while SV, CI, SVR and MAP were decreased. No significant changes of the SV or CI were observed during surgery. The Cdyn was significantly decreased. Conclusions: The steep lithotomy-Trendelenburg position induces moderate adverse hemodynamic and respiratory effects in healthy patients. These findings indicate the need for more active hemodynamic and respiratory monitoring in patients with a compromised cardiopulmonary function.