Where the breathing tube is removed after robotic surgery: operating room versus recovery unit

Impact of Site of Tracheal Extubation on Operating Room Efficiency During Robot-assisted Surgery: a Randomized Trial

This test sees if removing the breathing tube in the recovery room instead of the operating room shortens OR occupancy time and stays safe for adults having elective robot-assisted laparoscopic surgery.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 218 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Peking University First Hospital (other)
• Locations: 1 site (Beijing, Beijing Municipality)
• Trial ID: NCT07332806 on ClinicalTrials.gov

What this trial studies

Adults scheduled for elective robot-assisted laparoscopic surgery during daytime are assigned to have tracheal extubation either in the operating room (OR) or in the post-anesthesia care unit (PACU). The study compares OR occupancy time between the two extubation locations and records anesthesia-related adverse events and early quality of recovery. Investigators will monitor perioperative safety and patient recovery measures shortly after surgery to determine whether PACU extubation can improve turnover without increasing complications. Patients with major cardiac, pulmonary, airway, or sleep-disordered breathing risks are excluded.

Who should consider this trial

Good fit: Adults aged 18 or older scheduled for elective robot-assisted laparoscopic surgery during daytime hours who do not have severe obesity, diagnosed sleep apnea, high airway difficulty risk, significant cardiac or pulmonary disease, or other listed exclusions.

Not a fit: Patients with morbid obesity, diagnosed obstructive sleep apnea, anticipated difficult airway, significant cardiac or pulmonary conditions, or those having non-daytime/extubations outside the study window are unlikely to benefit or be eligible.

Why it matters

Potential benefit: If successful, this approach could shorten time spent in the operating room and improve OR turnover while maintaining patient safety after robotic surgery.

How similar studies have performed: Previous work in non-robotic surgeries has suggested PACU extubation can reduce OR time without substantially increasing complications, but evidence specifically for robotic-assisted procedures is limited.

Eligibility criteria

Inclusion Criteria:

1. Aged ≥18 years;
2. Scheduled to undergo elective robot-assisted laparoscopic surgery under general anesthesia;
3. Expected tracheal extubation during daytime working hours (before 4:00 PM).

Exclusion Criteria:

1. Refuse to participate in the study;
2. Morbid obesity (body mass index ≥35 kg/m²);
3. Preoperatively diagnosed obstructive sleep apnea, or patients with a STOP-Bang score ≥3 in combination with serum bicarbonate (HCO₃-) ≥28 mmol/L;
4. Patients at high risk of difficult airway (anticipated difficult intubation and/or extubation during preoperative assessment);
5. Preexisting sick sinus syndrome, severe sinus bradycardia (heart rate \< 50 beats/min), or second-degree or higher atrioventricular block without pacemaker implantation; congenital heart disease with any type of arrhythmia; or other severe cardiovascular diseases with New York Heart Association (NYHA) functional class ≥III;
6. Significant pulmonary function impairment (FEV₁/FVC ratio \< 70%, and total lung capacity \[TLC\] and vital capacity \[VC\] \< 80% of predicted values);
7. Severe hepatic dysfunction (Child-Pugh class C); severe renal dysfunction (estimated glomerular filtration rate \< 30 mL/min/1.73 m²); or American Society of Anesthesiologists (ASA) physical status classification ≥IV;
8. Preoperative diagnoses of schizophrenia, epilepsy, Parkinson's disease, or myasthenia gravis;
9. Inability to communicate due to coma, severe dementia, or language impairment;
10. Planned postoperative admission to the intensive care unit;
11. Any other conditions that are deemed for study participation.

Where this trial is running

Beijing, Beijing Municipality

• Peking University Fist Hospital — Beijing, Beijing Municipality, China (RECRUITING)

Study contacts

• Principal investigator: Dong-Xin Wang, MD, PhD — Peking University First Hospital
• Study coordinator: Dong-Xin Wang, MD, PhD

Conditions: Robotic Surgical Procedures, Airway Extubation, Operating Rooms, Anesthesia Recovery Period, Postoperative Complications