Improved oxygenation and lung compliance with recruitment maneuvers in robotic prostate surgery: A randomized trial

Background : This randomized controlled trial investigated the effects of recruitment maneuvers on arterial oxygenation and lung compliance in patients undergoing robotic-assisted prostatectomy in the steep Trendelenburg position. Hemodynamic parameters were also monitored, with no significant differences observed among groups. Methods : Sixty patients were randomly assigned to three groups (n = 20 each). • Group 1 received 0 cm H 2 O positive end-expiratory pressure (PEEP), • Group 2 received 5 cm H 2 O PEEP, • Group 3 received 5 cm H 2 O PEEP combined with two recruitment maneuvers, applied 5 minutes after CO 2 insufflation and 5 minutes after desufflation. Pneumoperitoneum was maintained at 12 mmHg. Anesthesia was maintained with sevoflurane and remifentanil infusion (FiO 2 50%), titrated to maintain end-tidal CO 2 (EtCO 2 ) between 30–36 mmHg. Balanced crystalloid solutions were administered at 4–6 mL/kg/h, adjusted according to hemodynamic parameters. Hemodynamic variables, arterial blood gases, and respiratory mechanics were recorded at predefined intraoperative and postoperative time points. Results : Group 3 demonstrated significantly higher PaO 2 and improved static and dynamic lung compliance compared to Group 1 (PaO 2 at T3: 155.0 ± 51.3 mmHg vs. 121.2 ± 25.2 mmHg; p = 0.014). EtCO 2 and peak heart rate (PHR) were significantly lower in Group 3 than in Group 1 (p = 0.018 and p = 0.007, respectively), though these findings were interpreted cautiously given potential vagal stimulation. Groups 2 and 3 both showed significantly better compliance and oxygenation than Group 1 (p < 0.001 and p = 0.006, respectively). No significant hemodynamic instability was observed. Conclusion : Recruitment maneuvers, when combined with moderate PEEP, may enhance intraoperative oxygenation and lung compliance during robotic prostatectomy without inducing significant hemodynamic compromise; however, the clinical relevance of these physiological improvements warrants further investigation in larger-scale studies.