Early Experience in Anesthesia of Robot Assisted Cystoprostatecomy

Abstract:

Objective:

Robot assisted cystectomies have recently been undertaken in our institute. We will discuss the perioperative management of the first 25 cases of robot-assisted cystprostatectomies with urinary diversion.

Methodology:

The study was conducted on 25 consecutive patients who underwent robotic radical cystprostatectomies with urinary diversion. Hemodynamic, pulmonary data and ABG changes were recorded.

Results: There were significant increase in mean arterial blood pressure ,CVP and arterial carbon dioxide tension, plateau airway pressure after pneumoperitoneum and trendlenberg position with significant decrease in lung compliance.

Conclusion: Robotic assisted radical cystectomy in the exaggerated trendlenberg position is a challenging clinical setting to anesthetists. Continuous monitoring intraoperatively and postoperatively with rapid interaction with anticipated events and potential risks is essential.

Keywords:Anesthesia monitoring; Robotically-assisted surgery ;trendelenburg position ; pneumoperitoneum.

Introduction

Minimally invasive surgery is being incorporated more frequently into urologic practice and appears to be replacing many open procedures.Robotically-assisted surgery is well established and will likely to play an increasingly important role in the future of surgical procedures. The technology of robotic assistance has the potential to improve the surgical outcome and overcome many limitations and reduce complications of conventional laparoscopy. [1,2] It allows better visualization, and more ergonomic instrument control and may be associated with several intra-and perioperative advantages in terms of blood loss, return to bowel function and hospital discharge but it has potential difficulties while on the steepest part of the learning curve.

The combination of the positioning and CO2 insufflations for long periods could make ventilating these patients challenging, and is likely to cause significant physiological...