Timing of Recruitment Maneuver in Robotic Prostate Surgery

Laparoscopic and robotic surgeries performed with carbon dioxide insufflation may cause clinically relevant physiological changes affecting pulmonary function. Pneumoperitoneum increases intra-abdominal pressure and, together with Trendelenburg positioning, may reduce functional residual capacity, decrease lung compliance, and promote atelectasis. These changes may contribute to hypoxemia and postoperative pulmonary complications.

Recruitment maneuvers are used to reopen collapsed alveolar units and may improve oxygenation and respiratory mechanics when combined with appropriate PEEP. Decremental PEEP titration is one method used to determine an individualized PEEP level after a recruitment maneuver by gradually reducing PEEP while monitoring oxygenation, respiratory compliance, and hemodynamic parameters.

The present study will evaluate whether the timing of recruitment maneuver application affects postoperative pulmonary outcomes in patients undergoing robotic prostate surgery. The study will compare recruitment maneuver performed before insufflation in the supine position with recruitment maneuver performed after insufflation and Trendelenburg positioning. Both groups will undergo individualized PEEP determination after the recruitment maneuver.

Inclusion criteria

• Patients scheduled for elective robotic prostate surgery
• Age 18 years or older
• Body mass index between 18 and 35 kg/m²
• No cognitive impairment
• Ability to provide written informed consent

Exclusion criteria

• Age younger than 18 years
• Emergency surgery
• Preoperative oxygen requirement
• Cognitive impairment
• Refusal to participate in the study