To study the changes in peak airway pressure after positioning and the effect of tenting of the abdominal wall on peak airway pressure in robotic radical prostatectomy surgery

Robotic radical prostatectomy is known for its requirement of pneumoperitoneum and deep Trendelenburg position. Such requirement comes with increased IAP (intra-abdominal pressure), decreased FRC (functional residual capacity), reduced pulmonary compliance and significant V/Q mismatch with hemodynamic instability. Deep Trendelenburg position causes cephalad shift of diaphragm leading to increased intra-thorasic pressure which is reflected on peak airway pressure in positive pressure ventilation, so increase in airway resistance and reduction in compliance potentiates the risk of barotrauma with positive pressure ventilation.
Tenting of the abdominal wall was performed after insertion of the abdominal port. After robotic arm docking, abdominal wall is lifted with the help of robotic arms with the aim of tenting which result in a decrease in intra-abdominal pressure, ultimately leading to decrease in peak airway pressure and to better ventilation.