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Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2025, vol. 31, issue3
Subject Area: Medicine
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DOI: 10.5272/jimab.2025313.6305
Published online: 07 July 2025
Original article
J of IMAB. 2025 Jul-Sep;31(3):6305-6312
ALVEOLAR RECRUITMENT MANEUVER FOR ROBOT-ASSISTED LAPAROSCOPIC SURGERY IN TRENDELENBURG POSITIONING
Atanas Zanev1, 2
, Mirela Neykova1, 2,
1) Department of Anesthesiology, Emergency and Intensive Care Medicine, Medical University, Varna, Bulgaria.
2) Clinic of Anesthesiology and Intensive Care, University Hospital "St. Marina" – Varna, Bulgaria.
ABSTRACT:
Purpose. This study aims to evaluate the effect of the alveolar recruitment maneuver on intraoperative lung function in patients undergoing robot-assisted surgery in the Trendelenburg position.
Materials and methods. A prospective, single-center randomized study was conducted at University Hospital "St. Marina" – Varna from June 2023 to July 2024, after approval by the Ethic Committee (No. 128/02.03.2023). 131 patients undergoing robot-assisted surgery in the Trendelenburg position were included. All patients were ventilated with VC/AutoFlow, a tidal volume (Vt) of 6-8 ml/kg, and respiratory rate (RR) adjusted according to ETCO2, targeting 28-42 mmHg. FiO2 was reduced after anesthesia induction to maintain SpO2 > 95%. In the experimental group, an alveolar recruitment maneuver (RM) was performed twice: first after Trendelenburg positioning and before pneumoperitoneum, and second after pneumoperitoneum and leveling of the operating table. At the end of the recruitment, Vt was maintained at 6-8 ml/kg and PEEP at 5 cmH2O. Surgeries were performed by a single surgical team using the da Vinci robotic system.
Results. The performance of the alveolar recruitment maneuver significantly increased dynamic lung compliance (Cdyn), particularly in obese patients. It also reduced peak inspiratory pressures (Ppeak) and allowed for a significant reduction in FiO2.
Conclusion. The alveolar recruitment maneuver is a valuable part of modern protective ventilation strategies, especially for preventing intraoperative pulmonary atelectasis. It can be considered a safe and effective method, particularly for obese patients and those undergoing robotic surgery in the Trendelenburg position.
Keywords: alveolar recruitment, Trendelenburg position, robot-assisted surgery, protective ventilation,
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Please cite this article as: Zanev A, Neykova M. Alveolar recruitment maneuver for robot-assisted laparoscopic surgery in Trendelenburg positioning. J of IMAB. 2025 Jul-Sep;31(3):6305-6312. [Crossref - 10.5272/jimab.2025313.6305]
Correspondence to: Atanas Zanev, MD, PhD, Clinic of Anesthesiology and Intensive Care, University Hospital "St. Marina" – Varna; 1, Hr. Smirnenski Blvd., 9010, Varna, Bulgaria; E-mail: naskozanev@gmail.com
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Received: 17 December 2024
Published online: 07 July 2025