Tracheal shortening during laparoscopic gynecologic surgery

Area of Science:

• Anesthesiology
• Surgical Procedures
• Respiratory Physiology

Background:

• Laparoscopic gynecologic surgery with pneumoperitoneum and Trendelenburg position can displace the carina toward the endotracheal tube (ETT) tip.
• This displacement reduces the safety margin for ETT placement, raising concerns about accidental endobronchial intubation.
• The impact of these surgical conditions on actual tracheal length remains unclear.

Purpose of the Study:

• To prospectively measure changes in tracheal length.
• To quantify the alteration in distance between the ETT tip and the carina during laparoscopic gynecologic surgery.
• To investigate the contribution of tracheal length changes to ETT-carina distance variations.

Main Methods:

• A prospective observational study involving 23 patients undergoing laparoscopic gynecologic surgery.
• Fiberoptic bronchoscopy was used to measure tracheal length and ETT tip-to-carina distance in the neutral position.
• Measurements were repeated after establishing carbon dioxide pneumoperitoneum and Trendelenburg positioning.

Main Results:

• In the neutral position, mean tracheal length was 11.09 cm and mean ETT tip-to-carina distance was 3.36 cm.
• After pneumoperitoneum and Trendelenburg positioning, the ETT tip-to-carina distance decreased by 0.85 cm.
• Tracheal length also decreased by 0.42 cm, accounting for approximately 49.7% of the observed reduction in ETT tip-to-carina distance.

Conclusions:

• Tracheal shortening occurs during laparoscopic gynecologic surgery under pneumoperitoneum and Trendelenburg positioning.
• This tracheal shortening contributes significantly to the decreased distance between the ETT tip and the carina.
• These findings highlight an increased risk of accidental endobronchial intubation in this surgical setting.