Anesthesia considerations for robotic surgery in gynecologic oncology

Robot-assisted gynecologic surgery is performed with a pneumoperitoneum and prolonged maximum Trendelenburg position which can result in adverse physiologic effects. The purpose of this study was to assess the feasibility of robot-assisted gynecologic oncology procedures and to identify anesthesia-related peri-operative adverse events. This is a case series performed on the first 133 patients who underwent a robot-assisted gynecologic oncology procedure at a tertiary care facility. Data was collected from electronically archived patient charts and from a prospective surgical database. Patient demographics were recorded and significant intra-operative and post-operative adverse events were reviewed. Robot-assisted surgery for gynecologic oncologic surgery with the use of extreme Trendelenburg in all patients was safely and successfully performed across a wide range of ages, American Society of Anesthesiologists physical status scores and body mass indices. Although most patients developed various degree of facial edema, only 5% of patients had a delayed extubation. Transient intra-operative hypoxemia (O2 saturation < 90%) occurred in 3.75% (5/133) of patients and hypercapnia (CO2 > 45 mmHg) in 18% (24/133). The mean duration of surgery was 254 min and median hospital stay was 1 day. Anesthetic and peri-operative complications are rare for patients undergoing robot-assisted gynecologic oncology surgeries despite the prolonged use of maximum Trendelenburg positioning and pneumoperitoneum. Although there are new anesthetic challenges, these surgeries were safely performed in a wide range of patients with minimal blood loss, short hospital stay and no significant cardiopulmonary complications.