Abstract
Technology keeps advancing in this era allowing surgery to become less invasive in many surgical sciences. Besides these technological advances, minimally invasive procedures such as laparoscopy and robotic assisted laparoscopy are preferred widely around the globe by both surgeons and patients. Because of the increasing demand to laparoscopy and robotic surgery, anesthetists also should adapt to these specific surgical procedures. Carbon dioxide (CO2) insufflation is applied in these procedures in order to provide working space and exposure to target organs. CO2 insufflation (pneumoperitoneum if applied intrabdominally) and positional maneuvers such as steep Trendelenburg position is used in urologic laparoscopy and robotic surgery, which have vital effects on patient’s physiology regarding cardiovascular, respiratory, renal, ocular and neurological systems. Special positions and unique surgical tools used in these procedures may hinder vital interventions such as cardiopulmonary resuscitation and open conversion. Comprehension of these pathophysiological effects and specific considerations is crucial to detect, to prevent and to manage serious complications that may occur during surgery.
Highlights
Invasive surgery is being applied more and more frequently in urology practice as it is in other surgical sciences
The aim of the procedures and the results obtained with the application of laparoscopic surgical techniques seem similar, the physiological effects of laparoscopy are very different from open surgery; minimal invasive surgery certainly requires a specific anesthetic management[1,2]
In order to provide the proper management of the patient undergone a laparoscopic or robotic assisted laparoscopic surgery and avoid the complications; one must thoroughly understand the effects of CO2 pneumoperitoneum and Trendelenburg position
Summary
Invasive surgery is being applied more and more frequently in urology practice as it is in other surgical sciences. In order to provide the proper management of the patient undergone a laparoscopic or robotic assisted laparoscopic surgery and avoid the complications; one must thoroughly understand the effects of CO2 pneumoperitoneum and Trendelenburg position. Pneumoperitoneum (both by increasing the intra-abdominal pressure and by causing hypercarbia) and Trendelenburg position itself has considerable effects on cardiac, pulmonary, renal and cerebrovascular physiology[5,6,7].
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