CLINICAL TRIAL article
Front. Surg.
Sec. Visceral Surgery
This article is part of the Research TopicEnhanced Recovery After Gastrointestinal SurgeryView all 9 articles
Laryngeal Mask Airway Versus Endotracheal Tube for Preventing Postoperative Atelectasis After Laparoscopic Surgery: A Randomized Controlled Trial
Provisionally accepted
- 1First Clinical Medical College, Lanzhou University, Lanzhou, China
- 2Lanzhou University, Lanzhou, China
- 3First Hospital of Lanzhou University, Lanzhou, China
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Background: Postoperative atelectasis is a common and clinically significant complication of general anesthesia, particularly during laparoscopic surgery due to reduced lung compliance and diaphragmatic elevation. In this study, the effects of a laryngeal mask airway (LMA) and endotracheal tube (ETT) on postoperative atelectasis after laparoscopic surgery were compared, and a predictive model for lung injury was developed. We hypothesized that the use of a laryngeal mask airway would be associated with reduced postoperative atelectasis compared with endotracheal intubation in patients undergoing laparoscopic surgery. Methods: In this single-center, assessor-blinded randomized controlled trial (ChiCTR2400094097), 192 adults (American Society of Anesthesiologists physical status I–III) undergoing elective laparoscopy (gastrointestinal, biliary, hernia, or gynecologic procedures) were randomized to LMA (n = 96) or ETT (n = 96) groups. All patients received lung-protective ventilation. Intraoperative respiratory mechanics (dynamic compliance and peak pressure) were monitored. Lung ultrasound (LUS) of 12 zones was performed preoperatively and 10 min after extubation by blinded investigators. An XGBoost model with SHAP identified predictors of LUS deterioration. The primary outcome was the LUS score (preoperative and 10 min postextubation). Results: In total, 186 patients completed follow-up. The ETT group showed significantly higher postoperative LUS scores compared with the LMA group (8.1 ± 1.9 vs. 5.6 ± 2.4, P < 0.001) as well as higher pulmonary complication rates (14% vs. 5.4%, P = 0.047). Airway complications, such as sore throat, were less frequent with LMA use. The XGBoost–SHAP model identified the intraoperative dynamic compliance decay rate as the strongest predictor of LUS deterioration. Conclusions: In laparoscopic surgery, laryngeal mask airway use is associated with reduced postoperative atelectasis and pulmonary complications compared with endotracheal intubation. Intraoperative deterioration in lung compliance may serve as an early indicator of postoperative lung aeration impairment detected by lung ultrasound.
Keywords: Atelectasis, Endotracheal intubation, general anesthesia, Laryngeal mask airway, lung ultrasound score, Postoperative pulmonary complications
Received: 21 Dec 2025; Accepted: 10 Feb 2026.
Copyright: © 2026 Lu, Zhang, Sun, Xing, Yang, Zhao, Song and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yongqi Wang
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