title: Anesthesia considerations for robotic surgery in gynecologic oncology.
abstract: Robot-assisted gynecologic surgery is performed with a pneumoperitoneum and prolonged maximum Trendelenburg position which can result in adverse physiologic effects. The purpose of this study was to assess the feasibility of robot-assisted gynecologic oncology procedures and to identify anesthesia-related peri-operative adverse events. This is a case series performed on the first 133 patients who underwent a robot-assisted gynecologic oncology procedure at a tertiary care facility. Data was collected from electronically archived patient charts and from a prospective surgical database. Patient demographics were recorded and significant intra-operative and post-operative adverse events were reviewed. Robot-assisted surgery for gynecologic oncologic surgery with the use of extreme Trendelenburg in all patients was safely and successfully performed across a wide range of ages, American Society of Anesthesiologists physical status scores and body mass indices. Although most patients developed various degree of facial edema, only 5% of patients had a delayed extubation. Transient intra-operative hypoxemia (O2 saturation < 90%) occurred in 3.75% (5/133) of patients and hypercapnia (CO2 > 45 mmHg) in 18% (24/133). The mean duration of surgery was 254 min and median hospital stay was 1 day. Anesthetic and peri-operative complications are rare for patients undergoing robot-assisted gynecologic oncology surgeries despite the prolonged use of maximum Trendelenburg positioning and pneumoperitoneum. Although there are new anesthetic challenges, these surgeries were safely performed in a wide range of patients with minimal blood loss, short hospital stay and no significant cardiopulmonary complications.
authors.affiliation: Department of Anesthesia, SMBD Jewish General Hospital, McGill University, 3755 Côte Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Badawy
authors.affiliation: Department of Anesthesia, SMBD Jewish General Hospital, McGill University, 3755 Côte Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada. fbeique@ana.jgh.mcgill.ca.
authors.forename: François
authors.initials: F
authors.lastname: Béïque
authors.affiliation: Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, 3755 Côte Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada.
authors.forename: Hani
authors.initials: H
authors.lastname: Al-Halal
authors.affiliation: Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, 3755 Côte Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada.
authors.forename: Tania
authors.initials: T
authors.lastname: Azar
authors.affiliation: Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, 3755 Côte Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada.
authors.forename: Khalid
authors.initials: K
authors.lastname: Akkour
authors.affiliation: Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, 3755 Côte Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada.
authors.forename: Susie K
authors.initials: SK
authors.lastname: Lau
authors.affiliation: Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, 3755 Côte Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada.
authors.forename: Walter H
authors.initials: WH
authors.lastname: Gotlieb
keywords: Anesthesia; Cervix cancer; Endometrial cancer; Gynecologic oncology; Robot-assisted surgery; Safety