Changes in diaphragmatic excursion and lung compliance during gynaecologic surgery: open laparotomy versus laparoscopy—a prospective observational study

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&ltype=&rtype=).

Effects of dynamic individualized PEEP guided by driving pressure in laparoscopic surgery on postoperative atelectasis in elderly patients: a prospective randomized controlled trial

“…In recent years, due to the advantages of a small incision and enhanced recovery after surgery, laparoscopic surgery has gradually become the primary abdominal surgery [ 1 ]. However, the establishment of pneumoperitoneum leads to the displacement of the diaphragm to the head, reduces the functional residual capacity (FRC), and promotes the formation of atelectasis, thus leading to impaired respiratory mechanics and gas exchange [ 2 , 3 ]. More importantly, pulmonary atelectasis underlies the pathophysiology of PPCs, the development of which may prolong hospital stays and increase mortality in surgical patients [ 2 – 5 ].…”

The effects of robot-assisted laparoscopic surgery with Trendelenburg position on short-term postoperative respiratory diaphragmatic function

“…The Trendelenburg position and pneumoperitoneum force the diaphragm towards the cranial side, leading to a decrease in lung volume and an increase in airway pressure. It has been suggested that the decrease in lung volume during surgery and the anatomical characteristics of the diaphragm itself are possible reasons for postoperative diaphragm movement impairment, although this view remains contentious [ 5 ]. Factors contributing to diaphragmatic dysfunction are multifaceted.…”

“…With the patient in the Trendelenburg position, gravity forces to keep the intestines away from the pelvis and abdominal cavity, which improves visualization and accessibility by creating more space in the surgical area and reduces the risk of injury by avoiding unexpected movement of organs and tissues. Although the Trendelenburg position provides numerous benefits during robot-assisted surgery, it is not without potential dangers, with the lungs and diaphragm bearing the brunt [ 4 , 5 ]. On one hand, the displacement of abdominal organs towards the chest leads to decreased lung volumes and compliance.…”

Impact of the Ultrasonographic Assessment of Lung and Diaphragmatic Function on Postoperative Respiratory Function in Patients Undergoing Abdominal Surgery

“…Among these patients, LUS most commonly manifests as B line signs in the gravity-dependent lung area and irregularities and ruptures of the pleura. The above-mentioned LUS signs appear not only due to the effect of gravity, which causes the liquid to distribute to the lowered part, resulting in changes in gasliquid distribution, but also considered to be related to the changes in the respiratory system of patients after induction of general anesthesia, which leads to lung in ation defects [21] .In addition, during laparoscopic surgery, the increase in intra-abdominal pressure pushes the diaphragm muscle cephalad, causing changes in lung volume that exacerbate the formation of atelectasis in the gravity-dependent area of the lung [25] . Monastesse et al [9] pointed out that although the pulmonary ventilation defect caused by pneumoperitoneum was not as severe as that induced by general anesthesia, a signi cant increase in LUSS after pneumoperitoneum could be observed.…”