Anesthetic Considerations With Telemanipulative Robot-Assisted Laparoscopic Cholecystectomy Using The Da Vinci System

Abstract

Background: A surgical telemanipulation system provides surgeons with tools to perform totally endoscopic laparoscopic surgery with several degrees of freedom of motion. The aim of this report is to identify the anesthetic considerations and the duration of surgery using the da Vinci operation robot for laparoscopic cholecystectomy. Patients and Methods: The computerized database (in the department of surgery) and the medical records of 14 patients who underwent roboticassisted laparoscopic cholecystectomy with CO2 insufflation under general anesthesia were studied. The study period covered one year from April 2003 until March 2004. Surgery and anesthesia times were identified. Results: The average time taken to set up the robot was 67±6 minutes. The average surgical time was 207±64 minutes. The average anesthesia time was 220±10 minutes. The average recovery time was 12±8 minuntes. The intraoperative average BIS figure was 43±4. The hemodynamic data were within normal ranges. The intraoperative average heart rate and mean blood pressure readings were 67±7 beat/min and 72±8 mmHg respectively. The average intraperitoneal CO2 insufflation pressure was 14±6 mmHg. All patients tolerated the procedure well. Conclusions: We believe that with robot-assisted surgery the anesthesiologist has to modify the anesthetic technique to be compatible with prolonged surgical hours with minimal side effects. Also, the anesthesiologist has to understand the risks and the possibility of technical difficulties encountered with robot-assisted surgery. We think that the cost of the system presents a major limiting factor for its widespread use in the field of surgery.