Randomized trial of pressure controlled versus volume controlled ventilation during robot assisted urological surgery in the clasp knife position
Abstract
The combination of CO₂ pneumoperitoneum and clasp-knife position imposes substantial respiratory and hemodynamic challenges in Da Vinci robot-assisted urological surgery. Although volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) are widely used, their comparative effects under these specific surgical conditions remain unclear. We hypothesized that PCV could reduce peak inspiratory pressure (Ppeak) and improve dynamic lung compliance (Cdyn) without compromising hemodynamic stability. The trial was retrospectively registered at ClinicalTrials.gov (NCT06056401). We randomized 62 ASA I–II patients to VCV (n = 30) or PCV (n = 32). Study measurements were discontinued in two PCV patients after randomization because of intraoperative bleeding, leaving 60 participants for the following analyses. Ventilatory parameters, hemodynamic variables, and arterial blood gas values were recorded at five time points: T1 (15 min after induction), T2 (15 min after clasp-knife positioning), T3 (30 min after CO₂ pneumoperitoneum), T4 (60 min after CO₂ pneumoperitoneum), and T5 (15 min after pneumoperitoneum removal). Ppeak showed a significant ventilation mode × time interaction ( P < 0.001). Lower Ppeak was observed in the PCV group at T2–T5, with the largest differences during pneumoperitoneum at T3 and T4. Cdyn also showed a significant ventilation mode × time interaction ( P = 0.012), with higher values under PCV at several measurement points. No significant ventilation mode × time interactions were observed for the measured arterial blood gas variables. No significant ventilation mode × time interactions were observed for the principal hemodynamic variables. No severe postoperative complications occurred during the 72-hour follow-up. PCV and VCV showed different intraoperative respiratory-mechanical profiles, including lower Ppeak and different Cdyn trajectories under PCV. No differential arterial blood gas or hemodynamic trajectories were observed, and the clinical significance of these physiological differences remains uncertain.
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BibTeX
@article{cai2026randomized,
title = {{Randomized trial of pressure controlled versus volume controlled ventilation during robot assisted urological surgery in the clasp knife position}},
author = {Xinyuan Cai and Jingwen Chen and Wenqian Lin and Lili Wen},
journal = {Scientific Reports},
year = {2026},
month = nov,
doi = {10.1038/s41598-026-77874-y},
url = {https://www.nature.com/articles/s41598-026-77874-y},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Randomized trial of pressure controlled versus volume controlled ventilation during robot assisted urological surgery in the clasp knife position
AU - Xinyuan Cai
AU - Jingwen Chen
AU - Wenqian Lin
AU - Lili Wen
PY - 2026
DA - 2026/11/02
JO - Scientific Reports
DO - 10.1038/s41598-026-77874-y
UR - https://www.nature.com/articles/s41598-026-77874-y
AB - The combination of CO₂ pneumoperitoneum and clasp-knife position imposes substantial respiratory and hemodynamic challenges in Da Vinci robot-assisted urological surgery. Although volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) are widely used, their comparative effects under these specific surgical conditions remain unclear. We hypothesized that PCV could reduce peak inspiratory pressure (Ppeak) and improve dynamic lung compliance (Cdyn) without compromising hemodynamic stability. The trial was retrospectively registered at ClinicalTrials.gov (NCT06056401). We randomized 62 ASA I–II patients to VCV (n = 30) or PCV (n = 32). Study measurements were discontinued in two PCV patients after randomization because of intraoperative bleeding, leaving 60 participants for the following analyses. Ventilatory parameters, hemodynamic variables, and arterial blood gas values were recorded at five time points: T1 (15 min after induction), T2 (15 min after clasp-knife positioning), T3 (30 min after CO₂ pneumoperitoneum), T4 (60 min after CO₂ pneumoperitoneum), and T5 (15 min after pneumoperitoneum removal). Ppeak showed a significant ventilation mode × time interaction ( P < 0.001). Lower Ppeak was observed in the PCV group at T2–T5, with the largest differences during pneumoperitoneum at T3 and T4. Cdyn also showed a significant ventilation mode × time interaction ( P = 0.012), with higher values under PCV at several measurement points. No significant ventilation mode × time interactions were observed for the measured arterial blood gas variables. No significant ventilation mode × time interactions were observed for the principal hemodynamic variables. No severe postoperative complications occurred during the 72-hour follow-up. PCV and VCV showed different intraoperative respiratory-mechanical profiles, including lower Ppeak and different Cdyn trajectories under PCV. No differential arterial blood gas or hemodynamic trajectories were observed, and the clinical significance of these physiological differences remains uncertain.
SN - 2045-2322
ER -