Anesthesia considerations for robotic-assisted laparoscopic prostatectomy: a review of 1,500 cases

Abstract

Prostate cancer is the second most common cancer in American men and new surgical techniques have led to less invasive options for prostate surgery. Innovations in robotic technology have enabled robotic systems to become a more common sight in operating theatres throughout the United States. Approximately 1,500 consecutive patients scheduled for elective robotic prostatectomy (RP) were reviewed. Patient demographics were recorded and significant intraoperative and postoperative events were reviewed. At our institution the mean age for patients undergoing RP is 60.3 (41–79) years; the mean body mass index is 27.3 kg m−2. The mean operative time, defined as the time from the start of insufflation to closure is 177.5 (81–365) min and mean blood loss is 109 (50–750) mL. There was a 1.3% incidence of postoperative anemia (hemoglobin <10 g dL) where patients required blood transfusions (15/1,500). Three patients were diagnosed with postoperative pulmonary emboli and were treated with IV heparin with no additional sequelae. The most common anesthesia-related complication was corneal abrasions, which were seen in 3% of cases. One patient required postoperative mechanical ventilation because of laryngeal edema secondary to multiple intubation attempts from an unexpectedly difficult airway. Anesthetic and perioperative complications are rare for patients undergoing robotic-assisted laparoscopic prostatectomy at our institution. Our institution has performed more robotic prostatectomies than any other institution in the world and we review our experience delivering anesthesia for the first 1,500 patients undergoing this operation.

Effects of Bowel Preparation and Fluid Restriction in Robot-Assisted Radical Prostatectomy Patients

“…In addition, fluid restriction reduces the airway oedema and facial oedema, which occur with the steep Trendelenburg position (13,14).…”

“…In RARP operations, a practical approach in fluid replacement is recommended as a 1-L bolus of lactated Ringer's solution before ureterovesical anastomosis and 1 L after completion of ureterovesical anastomosis and 2 L of crystalloid given throughout all cases and then continued at 150 mL h -1 for 12-24 hours (12,14,15). In some studies (5), fluid replacement is recommended as 30 mL kg -1 h -1 of hourly urine outflow after anastomosis, although in this method, the time to anastomosis can not be evaluated due to urine drainage into the abdominal cavity.…”

Anesthetic Management of a Patient Undergoing Robotic Assisted Renal Transplant

“…Postoperative pain after robotic assisted surgery is expected to be less than open conventional renal transplant as experiences obtained from other robotic surgical procedures [7]. A multimodal technique combining port site local anesthetic infiltration and post operative patient controlled analgesia can be a logical option; however, NSAIDs should be avoided.…”

Robotic surgery

“…134 Some special arrangements have to be made when performing robot-assisted surgery in the pelvis. Preoperatively, there is no need for a full bowel preparation, but it is advisable to use a laxative on the day before surgery.…”