Hemiparesis after robotic laparoscopic radical cystectomy and ileal conduit formation in steep Trendelenburg position

Robotic surgery is becoming popular for minimally invasive surgical procedures as robotic devices allow unprecedented control and precision. We report a case of robotic radical cystectomy with ileal conduit urinary diversion surgery having perioperative neurological complications related to prolonged surgery in the steep head-down position. There was a neurological deficit in the form of hemiparesis, which resolved with conservative management. We suggest that duration and positioning should be optimized for such prolonged surgery in the steep head-down position, and make some recommendations. Moreover, in such surgeries great vigilance must be observed in the perioperative period.