Joint consensus on anesthesia in urologic and gynecologic robotic surgery: specific issues in management from a task force of the SIAARTI, SIGO, and SIU

Aceto, Paola; Beretta, Luigi; Cariello, Claudia; Claroni, Claudia; Esposito, C.; Forastiere, Ester; Guarracino, Fabio; Perucca, Raffaella; Romagnoli, Stefano; Sollazzi, Liliana; Cela, Vito; Ercoli, Alfredo; Scambia, Giovanni; Vizza, Enrico; Ludovico, Giuseppe Mario; Sacco, Emilio; Vespasiani, Giuseppe; Scudeller, Luigia; Corcione, Antonio; Intensiva, Società Italiana di Anestesia Analgesia Rianimazione e Terapia; Urologia, Società Italiana di

doi:10.23736/s0375-9393.19.13360-3

Cited by 34 publications

(25 citation statements)

References 116 publications

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“…Poor candidates for robotic surgery generally include patients who may not tolerate insufflation or extremes of positioning well, and this will vary based on surgical location. Certain cardiopulmonary conditions such as severe pulmonary hypertension, or congenital heart disease including single-ventricle physiology or intra/extracardiac shunts, may not tolerate a pneumoperitoneum well [ 26 , 27 ]. The presence of ascites may result in challenging port placement.…”

Section: Indications/contraindications Of Ambulatory Robotic Surgerymentioning

confidence: 99%

Outpatient Robotic surgery: Considerations for the Anesthesiologist

Tameze¹,

Low²

2022

Advances in Anesthesia

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Section: Indications/contraindications Of Ambulatory Robotic Surgerymentioning

confidence: 99%

Outpatient Robotic surgery: Considerations for the Anesthesiologist

Tameze¹,

Low²

2022

Advances in Anesthesia

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“…The number and type of peripheral vascular access points required during robotic surgery depends on the type of surgery [1,3,5], as well as the patient's age, weight, and clinical condition [54][55][56]. The situation will also depend on the patient's vascular history and the manual skills of the anesthesiologist.…”

Section: Patient Accessmentioning

confidence: 99%

Pediatric robotic surgery: issues in management—expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP)

et al. 2022

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Background Pediatric robotic-assisted surgeries have increased in recent years; however, guidance documents are still lacking. This study aimed to develop evidence-based recommendations, or best practice statements when evidence is lacking or inadequate, to assist surgical teams internationally. Methods A joint consensus taskforce of anesthesiologists and surgeons from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP) have identified critical areas and reviewed the available evidence. The taskforce comprised 21 experts representing the fields of anesthesia (n = 11) and surgery (n = 10) from clinical centers performing pediatric robotic surgery in the Italian cities of Ancona, Bologna, Milan, Naples, Padua, Pavia, Perugia, Rome, Siena, and Verona. Between December 2020 and September 2021, three meetings, two Delphi rounds, and a final consensus conference took place. Results During the first planning meeting, the panel agreed on the specific objectives, the definitions to apply, and precise methodology. The project was structured into three subtopics: (i) preoperative patient assessment and preparation; (ii) intraoperative management (surgical and anesthesiologic); and (iii) postoperative procedures. Within these phases, the panel agreed to address a total of 18 relevant areas, which spanned preoperative patient assessment and patient selection, anesthesiology, critical care medicine, respiratory care, prevention of postoperative nausea and vomiting, and pain management. Conclusion Collaboration among surgeons and anesthesiologists will be increasingly important for achieving safe and effective RAS procedures. These recommendations will provide a review for those who already have relevant experience and should be particularly useful for those starting a new program.

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“…In 2019 Aceto et al [ 65 ] suggested using STP only for the time strictly necessary for surgery to be performed, using a position tailored to the pelvic operatory field of the subject and avoiding extreme TP (>30°) in high-risk patients.…”

Section: Implications For Practicementioning

confidence: 99%

The Impact of Steep Trendelenburg Position on Intraocular Pressure

Ripa

Schipa

Kopsacheilis

et al. 2022

JCM

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Intraocular pressure occurring during the Trendelenburg position may be a risk for postoperative visual loss and other ocular complications. Intraocular pressure (IOP) higher than 21 mmHg poses a risk for ocular impairment causing several conditions such as glaucoma, detached retina, and postoperative vision loss. Many factors might play a role in IOP increase, like peak expiratory pressure (PIP), mean arterial blood pressure (MAP), end-tidal CO2 (ETCO2) and surgical duration and some others (anaesthetic and neuromuscular blockade depth) contribute by reducing IOP during procedures requiring both pneumoperitoneum and steep Trendelenburg position (25–45° head-down tilt). Despite transient visual field loss after surgery, no signs of ischemia or changes to the retinal nerve fibre layer (RNFL) have been shown after surgery. Over the years, several studies have been conducted to control and prevent IOPs intraoperative increase. Multiple strategies have been proposed by different authors over the years to reduce IOP during laparoscopic procedures, especially those involving steep Trendelenburg positions such as robot-assisted laparoscopic prostatectomy (RALP), and abdominal and pelvic procedures. These strategies included both positional and pharmacological strategies.

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Joint consensus on anesthesia in urologic and gynecologic robotic surgery: specific issues in management from a task force of the SIAARTI, SIGO, and SIU

Cited by 34 publications

References 116 publications

Outpatient Robotic surgery: Considerations for the Anesthesiologist

Outpatient Robotic surgery: Considerations for the Anesthesiologist

Pediatric robotic surgery: issues in management—expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP)

The Impact of Steep Trendelenburg Position on Intraocular Pressure

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