[Anesthesia for robot-assisted surgery]

Robot-assisted surgery (RAS) has become firmly established in modern surgical practice, particularly in urology and is associated with well-documented surgical advantages. The combination of carbon dioxide pneumoperitoneum, often steep Trendelenburg positioning, prolonged operative times and restricted intraoperative patient access creates distinct physiological and organizational challenges for anesthetic management. This narrative review summarizes the anesthesiological implications of RAS with a focus on urological procedures. Relevant changes in respiratory mechanics during RAS include decreased lung compliance, increased airway pressures and impaired gas exchange. These changes require individually tailored lung-protective ventilation strategies. Hemodynamic alterations essentially result from increased intra-abdominal pressure and positional effects, including increased afterload, altered venous return and reduced cardiac efficiency, particularly in patients with limited cardiopulmonary reserve. Head and neck venous congestion can lead to airway edema and increased intraocular and intracranial pressures, while neurocognitive disorders are an additional concern in vulnerable patient populations. The generally poor accessibility of patients during RAS highlights the importance of meticulous preoperative planning, appropriate monitoring, standardized positioning and clearly defined emergency protocols. In particular, for patients with cardiopulmonary or neurocognitive risks an individual strategy is decisive to minimize perioperative morbidity. Ensuring the safety of anesthesia for RAS requires anticipating procedure-specific physiological stressors, providing individualized perioperative management and ensuring effective interdisciplinary coordination. Standardization, simulation-based training and protocol-driven emergency preparedness are essential to enhance patient safety as the use of robotic surgery continues to expand.