Cardiac Function and Hemodynamic Changes during Minimally Invasive Hysterectomy with Pneumoperitoneum and Steep Trendelenburg Position for Patients with Endometrial Cancer Who Are Obese

Study Objective: To assess the effect of carbon dioxide (CO2) pneumoperitoneum and steep Trendelenburg position on patients' cardiac function and hemodynamics during minimally invasive staging surgery for endometrial cancer. Design: Single-center prospective longitudinal study. Setting: University-affiliated tertiary hospital. Patients: Patients with endometrial cancer undergoing minimally invasive surgery. Interventions: After consent, the patients' hemodynamic parameters were assessed by the Non-Invasive Cardiac System (NI Medical, Petah Tikva, Israel) at 5 time points: before general anesthesia, after induction of general anesthesia, after CO2 insufflation of the peritoneum, after steep Trendelenburg position, and at the end of surgery. Measurements and Main Results: Twenty-three women were recruited. The median age of the patients was 68 years (interquartile range [IQR] 62-75), with a median body mass index of 34.9 kg/m(2) (IQR 31.2-39.5) and an American Society of Anesthesiologists score >= 2. The initial median mean arterial pressure was 108 mmHg (IQR 101-113), and the baseline median cardiac output was 7.2 L/min (IQR 5.6-8.7). The median mean arterial pressure significantly decreased by 18% after insufflation (p =.001), again after Trendelenburg position (p=.003), and did not fully recover at the end of surgery in comparison with the preanesthesia baseline (p=.001). The median stroke volume significantly decreased by 17% after insufflation compared with the baseline (p=.01) and then gradually recovered to the baseline levels by the end of surgery. The median cardiac power significantly decreased by 35% after insufflation (0.009), remained low during Trendelenburg position (p=.009), and recovered by the end of surgery to 18% below the baseline levels (p=.035). Conclusion: Significant hemodynamic changes occur during minimally invasive staging surgery for endometrial cancer. CO2 insufflation is accompanied by the most dramatic hemodynamic deterioration during surgery, and this does not get affected much with Trendelenburg. Knowledge of the hemodynamic values of women classified as high risk when using a noninvasive technique during surgery is obtainable and may assist both surgeon and anesthesiologist to ensure a safer procedure. (C) 2020 AAGL. All rights reserved.

Automated summary

This study assessed the effects of CO2 pneumoperitoneum and steep Trendelenburg position on cardiac function and hemodynamics in endometrial cancer patients undergoing minimally invasive surgery. Significant hemodynamic changes were observed during surgery, with CO2 insufflation causing the most dramatic deterioration. Knowledge of hemodynamic values in high-risk women during surgery may help ensure a safer procedure.