Objective To investigate the effect of early respiratory training in the post‑anesthesia care unit (PACU) on postoperative pulmonary atelectasis in patients undergoing gynecologic laparoscopic surgery. Methods A total of 62 patients who underwent gynecological laparoscopic surgery under general anesthesia from November 2022 to April 2023 were included in the study. After exclusion and using the block randomization method, the patients were divided into two groups: a respiratory training group (group R, n=30) and a control group (group C, n=30). After admission to PACU, all the patients were subject to oxygen inhalation by mask. Patients in group R, when they were conscious and could cooperate, underwent breathing training with the assistance of nurses through fitting the mask to their faces. When the lower pressure limit of the anesthesia machine in the manual mode was set as 5, 5, and 10 cmH2O (1 cmH2O=0.098 kPa), the patients were instructed to inhale and exhale deeply, and three deep breaths were set as one group, with an internal of 5 min per group for a total of three groups. Patients in group C were routinely monitored for oxygenation, without intervention. Ultrasound technology was applied to scan the lungs in subregions (12 regions in total) and scored using the modified lung ultrasound score (LUS) upon admission to the operating room (T1), after removal of the tracheal tube at the end of anesthesia (T2), and at the time of PACU discharge (T3). The scores ranged from 0 to 3 points for each region, and the total score was 0 to 36 points on both sides. Their general information, the number of cases of pulmonary atelectasis, the modified LUS at T1, T2 and T3, the pulse oxygen saturation (SpO2) at T3, and the incidences of hypoxemia, dyspnea and pneumonia within the postoperative follow‑up of 48 h were recorded. Results There was no statistical difference in general information between the two groups (all P>0.05). Compared with those at T2, both groups showed decreases in modified LUS and the number of cases of pulmonary atelectasis at T3, with statistical difference (all P<0.05). There was no statistical difference in the number of cases of pulmonary atelectasis and modified LUS between group R and group C at T2 (all P>0.05). The number of cases of pulmonary atelectasis and modified LUS in group R at T3 was significantly lower than those in group C (all P<0.05). Patients in group R presented a significantly higher SpO2 at T3, compared with those in group C (P<0.05). No postoperative hypoxemia, dyspnea, or pneumonia was observed at follow‑up in both groups. Conclusions Early respiratory training in PACU can significantly improve the modified LUS after general anesthesia and reduce the incidence of postoperative pulmonary atelectasis in patients undergoing gynecologic laparoscopic surgery.