Considerations for anesthesiology in robotic-assisted surgeries
Adoption of robotic-assisted surgery has increased recently, which can be attributed to its advantages over conventional laparoscopic techniques. These include increased instrument dexterity and precision, improved surgeon ergonomics, three-dimensional camera view, and stability of the camera platform. However, anesthesiologists are required to manage the unique challenges associated with robotic-assisted surgery, including steep patient positioning, pneumoperitoneum, and limited patient access. This article outlines the significant physiological impact on the cardiovascular and respiratory systems of the combined effects of pneumoperitoneum and steep positioning, and provides recommended practices to mitigate the risk of airway edema and optimize perioperative ventilation, fluid management, and analgesia. Providers should take care with patient and robot positioning to avoid pressure or nerve injuries. Finally, patient access limitations demand meticulous securement of the endotracheal tube, intravenous lines, patient monitors, and for the operative team to be familiar with emergency undocking protocols.
