FACTS ABOUT THE SURGERY

There is a master console; surgeon sits here & controls the robotic surgical manipulator, once it has been docked

Robot is bulky and is positioned over the chest and abdomen

Patient is positioned in lithotomy with a steep Trendelenberg tilt

Needs immobility of the patient till the robot is undocked

Table position should not be altered until the surgical instruments are disengaged

Discharge may occur as early as within 24 hours after surgery

ADVANTAGES

Better continence & erectile function
Less pain and hence less analgesic requirements
Less blood loss
Shorter hospital stay

ANESTHESIA CONCERNS

Since immobility is very important, it can be established by continuous infusion of a non depolarizing muscle relaxant

As the procedure may take long time, it’s better to use agents with rapid offset

Because patient is positioned in steep head-down position

Ensure pressure points are protected adequately

Fluids are infused cautiously to reduce chances of cerebral and laryngeal oedema ( N.B.: Rule out cerebral oedema in case of delayed emergence )

As the position of the robot interferes with resuscitation, prior practice-drills and good communication are necessary to manage such a situation effectively

Epidural analgesia, if at all required, are used only postoperatively, as the steep head-down position will increase the risk of high block

Reference: Irvine M, Patil V. Anaesthesia for robot-assisted laparoscopic surgery. Contin Educ Anaesth Crit Care Pain. 2009; 9(4): 125–129.

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