[Authors's reply to "Preventing atelectasia at robotic surgery"].

e letter by Yetim et al. discussed mechanical ventiion modes and parameters to prevent hypoxemia and prove lung function during robotic surgery, using Recruitnt Maneuvers (RMs), positive pressure ventilation mode, d Positive End-Expiratory Pressure (PEEP).1 We agree that pressure control ventilation is an option d PEEP and RMs may be needed during robotic surgery. wever, some studies have reported that PEEP and RMs may prove gas exchange during laparoscopic surgery, whereas ers have shown no changes.2 In both our robotic cystomy and prostatectomy series, patients in the deep ndelenburg position and with intra-abdominal pressure e to pneumoperitoneum tended to generate auto-PEEP as ll as high inspiratory peak and plateau pressures. Hower, adjusting the ventilator settings to a higher breathing quency with respect to auto-PEEP values and to a lower al volume using a volume-controlled ventilator mode was ry helpful in obtaining normal values for peak and plateau ssures and in avoiding the generation of auto-PEEP. hough PEEP can improve gas exchange in these patients, was not needed because of the very few instances auto-PEEP. Additionally, no signs of low hemoglobin ygen saturation and/or hypoxemia were observed on artel blood gas analysis, and atelectasis was not diagnosed in y patient. However, it is possible that PEEP and RMs may be needed even in dual-controlled ventilation modes, and they can be considered in hemodynamically stable cases.