"In robotic surgery the surgeon sits at a console while a bulky robot is docked to an immobile patient in steep head-down tilt with a CO₂-filled abdomen. The anaesthetist trades easy access to the patient for a set of predictable physiological insults — and must keep the patient perfectly still, because the patient cannot move once the arms are locked."
How to use this topic — CritCare.in.Anaesthesia for Robot-Assisted Surgery
A newer field of surgery in which operations are carried out with the surgeon at a robotic console while the robot is docked at the surgical site. The pelvic prostatectomy is the classic case — done in steep Trendelenburg with CO₂ pneumoperitoneum — and the same principles extend to robotic gynae-oncology, colorectal and renal surgery.
- Anticipate the physiology of steep Trendelenburg + pneumoperitoneum (↑ myocardial demand, ↓ compliance, ↑ ICP/IOP), select patients who can tolerate it, and manage the docked robot — total immobility, restricted patient & airway access, meticulous positioning/padding and eye protection — with restrictive fluids until the anastomosis is done.
Steep Trendelenburg & Pneumoperitoneum
The cardiovascular, respiratory, cerebral, ocular & renal effects of head-down tilt plus a CO₂-insufflated abdomen.
📋02 · PRE-OPPatient Selection
High-risk identification and the relative contraindications to steep Trendelenburg — who should have open surgery instead.
💉03 · INTRA-OPThe Docked Robot
Immobility & restricted access, long lines/circuits, induction, positioning & padding, endobronchial migration and restrictive fluids.
⚠️04 · COMPLICATIONSPOVL & the Position Complications
Post-operative visual loss, airway/facial oedema, subcutaneous emphysema, hypercarbia and nerve injuries.
🎓05 · PEARLSRecovery, Mistakes & References
Reversal & extubation (airway-oedema check), common mistakes, exam pearls and references.