Effects of lung protective ventilation on postoperative respiratory parameters in patients undergoing robot-assisted radical prostatectomy


To investigate the effects of lung protective ventilation (LPV) compared to conventional ventilation (CV) on postoperative respiratory parameters in patients undergoing robot-assisted radical prostatectomy (RARP). In total, 24 patients undergoing RARP were randomized to two groups receiving either LPV with a tidal volume of 6 ml/IBW with a positive end-expiratory pressure (PEEP) of 10 cm H2O (intervention) or CV with a tidal volume of 10 ml/IBW with a PEEP of 4 cmH2O (control). Primary endpoint was PaO2 2 h postoperatively after 10 min of spontaneous respiration of atmospheric air. Forced expiratory volume during the first second (FEV1), forced vital capacity (FVC), diffusion capacity (DLCO), and plasma interleukin-6 (IL-6) was measured before and after the surgery. Pulmonary complications were registered within the first year after surgery. All patients completed the study. No difference was found in PaO2 between LPV and CV. However, 4 patients in the LPV group had a decrease in saturation below 90% during the 10 min of spontaneous respiration of atmospheric air compared to none in the CV group. FEV1, FVC, and DLCO were similar when comparing the two groups at all timepoints and no patients in either of the groups had pulmonary complications during the first postoperative year. IL-6 levels increased during surgery in both groups, but were not significantly different between the two groups. We found no evidence of lung protective effects of LPV compared to CV estimated by pulmonary function tests, IL-6 levels and postoperative complications in patients undergoing RARP. Surprisingly, only patients in the LPV group and none in the CV group had a decline in saturation below 90% during the 10 min of breathing atmospheric air.

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The authors greatly acknowledge nurse Brigitta Willumsen, all the nurses and anaesthesiologists of the Department of Anaesthesiology, urologists Lars Høst, MD, Stefan Vind-Kezunovic, MD, Morten Andersen, MD, Niels T. Mikkelsen, MD, and the nursing staff of the Department of Urology, for their help and practical assistance during the study. Furthermore, the authors thank the personnel of the laboratory.

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Correspondence to Mette Mølsted.

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Jørgen Bjerggaard Jensen is proctor for Intuitive Surgery. Mette Mølsted, Peter Ekeløf, Jesper Nørgaard Bech, and Jost Wessels declare that they have no conflict of interest.

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Mølsted, M., Ekeløf, P., Bech, J.N. et al. Effects of lung protective ventilation on postoperative respiratory parameters in patients undergoing robot-assisted radical prostatectomy. J Robotic Surg 14, 509–516 (2020). https://doi.org/10.1007/s11701-019-01016-y

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  • Prostate cancer
  • Robotic surgery
  • Prostatectomy
  • RARP
  • Lung protective ventilation
  • Pulmonary complications