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Subcostal Specimen Removal in Completely Portal Robotic Lobectomy

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Robotic thoracic surgery: what is different in anesthesia?

Laszlo L Szegedi¹, Turgay Tuna¹, Evangelia Samara²

¹Department of Anesthesiology, Université Libre de Bruxelles, H.U.B Hôpital Erasme, Brussels, Belgium.

Current Opinion in Anaesthesiology

|November 12, 2025

Summary

This summary is machine-generated.

Robotic-assisted thoracic surgery (RATS) presents unique anesthetic challenges. Tailored strategies for airway management, ventilation, and patient monitoring are crucial for optimizing outcomes in RATS procedures.

Keywords:

anesthesia carbon dioxide insufflation enhanced recovery one-lung ventilation robotic thoracic surgery

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Area of Science:

Anesthesiology
Thoracic Surgery
Robotic Surgery

Background:

Robotic-assisted thoracic surgery (RATS) offers enhanced precision for minimally invasive lung, esophageal, and mediastinal resections.
RATS introduces specific anesthetic challenges distinct from traditional thoracic surgery.

Purpose of the Study:

To review the anesthetic challenges and advances in robotic-assisted thoracic surgery.
To highlight strategies for optimizing patient safety and surgical success in RATS.

Main Methods:

Review of current anesthetic management strategies for RATS.
Discussion of challenges including carbon dioxide insufflation and one-lung ventilation.
Exploration of advanced techniques like individualized lung isolation and protective ventilation.

Main Results:

Anesthetic management requires tailored approaches for RATS, considering patient-specific factors and surgical demands.
Protective ventilation, restrictive fluid strategies, and deep neuromuscular blockade are key components.
Enhanced recovery after surgery (ERAS) pathways and regional anesthesia improve outcomes and reduce opioid use.
Novel approaches like AI and subpleural infusion are emerging.

Conclusions:

RATS necessitates integrated anesthetic strategies focusing on airway, ventilation, hemodynamics, and analgesia.
Adherence to ERAS principles is vital for improved patient recovery.
Future directions include AI-supported monitoring and standardized training.