Anesthesia for Robot-Assisted Radical Prostatectomy - a Challenge for Anaesthesiologist

Abstract

Mininimally invasive surgery has become one of the most popular ones over the last few decades due to many benefits. The advantages are minimal surgical incision, reduced blood loss, reduced postoperative pain, faster postoperative recovery, shorter hospital stay, lower morbidity and better outcomes compared to open surgery. The most common robotic procedures in urology are radical prostatectomies. In UHC Zagreb, since November 2019 until now, there have been more than 180 robotic assisted radical prostatectomies (RALP) using Senhance robotic system performed. As a procedure with many possible complications, it represents a challenge for anaesthesiologist. Some of the problems the anaesthesiologists have to face are related to limited patient access, possible difficulties connected with positioning, pneumoperitoneum, subcutaneous emphysema, possible airway oedema. Pneumoperitoneum has impact on almost every system: cardiovascular, renal, respiratory, gastrointestinal and other. Detailed understanding of physiological changes of RALP, with intraoperative impact on nearly every body system is ultimate. Careful preoperative evaluation and intraoperative conduction minimize the risk of complications, and help patients to reach full recovery in a very short time. Excellent outcomes are the result of individualized approach to the patient and good communication between team members.

Anesthetic Management of a Patient With Wolff-Parkinson-White Syndrome Undergoing Gynecological Robotic Surgery

“…Robotic surgery represents a new frontier of minimally invasive surgery and the evolution of laparoscopic surgery in terms of precision and safety, with a reduction of operating times, complications, and postoperative pain, and the use of opioids in the perioperative period; all this translates into shorter hospitalization times, so much so that robotic surgery can be fully included in the enhanced recovery after surgery (ERAS) protocols [1]. However, anesthetic management in robotic surgery represents a challenge for the anesthesiologist due to the changes that occur in the body's homeostasis [2,3]. These alterations occur mainly at the hemodynamic and respiratory levels due to the extreme position assumed by the patient (Trendelemburg 25-30°) and the pneumoperitoneum [2].…”