Halil Islamoglu‡, Bilge Aslan‡, Ayça Dumanlı Özcan‡, Abdülkadir But§Corresponding author: Bilge Aslan ( drbilgeaslan@hotmail.com ) Academic editor: Pencho Tonchev © Halil Islamoglu, Bilge Aslan, Ayça Dumanlı Özcan, Abdülkadir But. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Citation:
Islamoglu H, Aslan B, Dumanlı Özcan A, But A (2026) Improved oxygenation and lung compliance with recruitment maneuvers in robotic prostate surgery: A randomized trial. Journal of Biomedical and Clinical Research 19: 129-140. https://doi.org/10.3897/jbcr.e176808 |  |
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 H2O positive end-expiratory pressure (PEEP),
• Group 2 received 5 cm H2O PEEP,
• Group 3 received 5 cm H2O PEEP combined with two recruitment maneuvers, applied 5 minutes after CO2 insufflation and 5 minutes after desufflation.
Pneumoperitoneum was maintained at 12 mmHg. Anesthesia was maintained with sevoflurane and remifentanil infusion (FiO2 50%), titrated to maintain end-tidal CO2 (EtCO2) 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 PaO2 and improved static and dynamic lung compliance compared to Group 1 (PaO2 at T3: 155.0 ± 51.3 mmHg vs. 121.2 ± 25.2 mmHg; p = 0.014). EtCO2 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.