Kübra TAŞKIN, Cansu OFLUOĞLU
Laparoscopic Endoscopic Surgical Science - 2025;32(4):256-265
Introduction: Laparoscopic gynecologic surgery in the steep Trendelenburg position alters pulmonary mechanics and oxygenation. The optimal ventilation mode remains uncertain. Materials and Methods: In this prospective, randomized controlled trial, 60 patients (20 per group) undergoing elective laparoscopic gynecologic surgery in the steep Trendelenburg position were randomly assigned to Volume-Controlled Ventilation (VCV), Pressure-Controlled Ventilation (PCV), or Pressure-Controlled Volume-Guaranteed Ventilation (PCV-VG(R)). The primary outcome was peak airway pressure (Ppeak). Secondary outcomes included other respiratory variables, oxygenation parameters, and hemodynamic variables. Results: Ppeak and Pplateau values were significantly higher in the VCV group compared to the PCV and PCV-VG(R) groups at T2, T3, and T4 (p<0.01). After Bonferroni correction, these differences remained significant between VCV and the other groups, while no difference was found between PCV and PCV-VG(R). PaCO2 levels were significantly lower in the PCV-VG(R) group compared to VCV and PCV at T3 (p=0.008). No significant differences were observed in PaO2, SaO2, Pmean, exhaled tidal volume, or hemodynamic parameters. Conclusions: Both PCV and PCV-VG(R) provided lower airway pressures and better lung compliance than VCV, while PCV-VG(R) additionally improved CO2 elimination. PCV-VG(R) may be a favorable ventilation strategy in laparoscopic gynecologic surgery performed in the steep Trendelenburg position.
