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Electrical impedance tomography: changes in distribution of pulmonary ventilation during laparoscopic surgery in a porcine model

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Abstract

Background

Because of the creation of a pneumoperitoneum, impairment of ventilation is a common side-effect during laparoscopic surgery. Electrical impedance tomography (EIT) is a method with the potential for becoming a tool to quantify these alterations during surgery. We have studied the change of regional ventilation during and after laparoscopic surgery with EIT and compared the diagnostic findings with computed tomography (CT) scans in a porcine study.

Materials and methods

After approval by the local animal ethics committee, six pigs were included in the study. Two laparoscopic operations were performed [colon resection (n=3) and fundoplicatio (n=3)]. The EIT measurements (6th parasternal intercostal space) were continuously recorded by an EIT prototype (EIT Evaluation Kit, Dräger Medical, Lübeck, Germany). To verify ventilatory alterations detected by EIT, a CT scan was performed postoperatively.

Results

Ventilation with defined tidal volumes was significantly correlated to EIT measurements (r 2=0.99). After creation of the pneumoperitoneum, lung compliance typically decreased, which agreed well with an alteration of the distribution of pulmonary ventilation measured by EIT. Elevation of positive end-inspiratory pressure reopened non-aerated lung areas and showed a recovery of the regional ventilation measured by EIT. Additionally, we could detect pulmonary complications by EIT monitoring as verified by CT scans postoperatively.

Conclusion

EIT monitoring can be used as a continuous non-invasive intraoperative monitor of ventilation to detect regional changes of ventilation and pulmonary complications during laparoscopic surgery. These EIT findings indicate that surgeons and anesthetists may eventually be able to optimize ventilation directly in the operating theatre.

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Acknowledgements

We thank Eckhard Teschner, Dräger Medical, for technical support and Dr. Ralf Noel, Doctor of Veterinary Medicine, University of Lübeck, for help with the animal preparations.

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Authors and Affiliations

  1. Department of Anesthesiology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    T. Meier, U. W. Gosch, M. Grossherr & H. Gehring

  2. Department of Radiology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    T. Leibecke

  3. Department of Surgery, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    C. Eckmann & H. P. Bruch

  4. Medical Information Technology, Helmholtz Institute, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany

    S. Leonhardt

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  1. T. Meier
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  2. T. Leibecke
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  3. C. Eckmann
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  4. U. W. Gosch
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Correspondence to T. Meier.

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Meier, T., Leibecke, T., Eckmann, C. et al. Electrical impedance tomography: changes in distribution of pulmonary ventilation during laparoscopic surgery in a porcine model. Langenbecks Arch Surg 391, 383–389 (2006). https://doi.org/10.1007/s00423-006-0034-8

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  • DOI: https://doi.org/10.1007/s00423-006-0034-8

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