The Docked-Robot Environment
🔒 Once the robot is docked, you cannot reach the patient
- Total immobility is mandatory — if the patient moves while the arms are locked, the instruments can injure viscera. Ensure deep neuromuscular block & adequate anaesthetic depth throughout.
- Restricted access to the patient and the airway; the bulky robot arms crowd the field.
- Use long IV-line extensions and long breathing circuits, secured & accessible before docking.
- Communication with the console surgeon is harder — agree signals for "stop / undock" emergencies.
Induction, Positioning & Ventilation
Intra-operative sequence
Access & monitoring firstSecure IV lines with extensions; fluid warmer; ECG, NIBP, SpO₂, temperature, urine output, airway pressure, EtCO₂; add arterial line (IBP) if bleeding risk is high
InductionAvoid long-acting sedatives; propofol 1–2 mg/kg + fentanyl 1–2 µg/kg + a non-depolariser (vecuronium/atracurium/rocuronium); secure airway with an ETT; pass an orogastric/RT tube to reduce aspiration risk
Positioning & paddingPad all bony prominences, use non-sliding supports, and PAD/PROTECT THE EYES; secure the patient against the steep tilt without shoulder-brace nerve injury
Re-check the tube after positioningSteep Trendelenburg + pneumoperitoneum shift the carina cephalad → endobronchial migration; auscultate again for bilateral air entry after position & insufflation
Maintenance & ventilation
- Volatile (sevoflurane) in O₂/air
- Lung-protective: TV 6–8 mL/kg + PEEP to prevent atelectasis; limit plateau pressure; increase minute ventilation to clear the CO₂ load; watch peak airway pressures
Blunting the sympathetic response
- Nitroglycerine 0.5–2 µg/kg/min, propofol, or dexmedetomidine to control the insufflation/positioning pressor response
Restrictive Fluids & Analgesia
Why restrictive fluids until the anastomosis
- Keep intra-operative fluids restrictive — this reduces airway/facial oedema and reduces urine production, because a wet field obscures visibility before the urethral anastomosis. Once the anastomosis is complete, IV fluid can be given more liberally as required.
Multimodal analgesia: NSAIDs, opioids, paracetamol, local-anaesthetic infiltration of port sites, ± a regional block (e.g. quadratus lumborum / TAP).