Changes of Diaphragmatic Excursion and Lung Compliance during Gynecologic Surgery: Open Laparotomy versus Pelviscopy

Abstract

Introduction: The present study aimed to compare the impact of type of surgery on diaphragmatic excursion and lung compliance during operation between open radical hysterectomy and laparoscopic radical hysterectomy. Methods: Total forty patients, twenty of open radical hysterectomy and twenty of laparoscopic radical hysterectomy, were enrolled. Diaphragmatic excursions were measured in tidal ventilation using M-mode sonography before the intubation (T0), after the intubation with mechanical ventilation (T1), 90 minutes (T2) after incision, and at the end of operation with recovery of muscle relaxation (T3). Pulmonary parameters such as peak inspiratory pressure and static lung compliance were measured using an anesthesia machine combined with a ventilator. Results: Diaphragmatic excursion in patients who underwent laparoscopic radical hysterectomy was significantly lower than those of open radical hysterectomy 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 defined as less than 10mm of diaphragmatic excursion under mechanical ventilation occurred in 15 patients (83.3%) who underwent laparoscopic radical hysterectomy while there were 7 patients (38.9%) had diaphragmatic impairment in open group (P = 0.006). The changes in peak inspiratory pressure and static lung compliance over time were significantly different between the two groups (P < 0.001, respectively). Conclusion: Laparoscopic radical hysterectomy decreased diaphragmatic excursion and static lung compliance more severely than open radical hysterectomy since it requires Trendelenburg position and pneumoperitoneum.