Assessment of Diaphragmatic Function in Robotic Surgery vs Open Abdominal Surgery Under General Anaesthesia - A Prospective Observational Clinical Study.

The diaphragm is the main muscle of respiration. Diaphragmatic dysfunction can be mild (weakness) or severe (with diaphragmatic paralysis). In the perioperative setting multiple factors affect the diaphragmatic function such as surgical procedure, mechanical ventilation and post operative pain. Unrecognized diaphragmatic dysfunction can result in several complications for the patient including prolonged recovery time and postoperative pulmonary complications. Over the years several methods of assessing diaphragmatic function have been used. Ultrasonography of the diaphragm has turned out to be one of the most reliable methods for bedside assessment of diaphragmatic dysfunction showing a sensitivity of 93% and specificity of 100% in neuromuscular disease. (1) Over the years surgeries are evolving to become more and more minimally invasive to increase patient comfort in the postoperative period and faster recovery. The evolution of robotic surgery comes with a challenge as it is associated with unphysiological conditions from the pneumoperitoneum created for the surgery. It results in a cephalad displacement of the diaphragm and mechanical compression of the lungs. This can be further worsened depending on the position of the patient during surgery as seen with trendelenburg position. Perioperative use of diaphragmatic US is limited due to patient position factors and has not been explored much. Through this study we aim to gain some insights on diaphragmatic dysfunction occurring in surgeries involving creation of pneumoperitoneum as compared to open surgeries.