Anesthetic concerns for robotic-assisted laparoscopic radical prostatectomy: an update

The anesthetic concerns of patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) are primarily related to the use of pneumoperitoneum in the steep Trendelenburg position. This combination will affect cerebrovascular, ocular, respiratory, and hemodynamic homeostasis. Possible non-surgical complications range from mild subcutaneous emphysema to devastating ischemic optic neuropathy. The anesthetic management of RALP patients involves a thorough preoperative evaluation, careful positioning on the operative table, managing ventilation issues, and appropriate fluid management. Close coordination between the anesthesia and surgical teams is required for a successful surgery. This updated review will discuss the anesthetic concerns and perioperative management of patients presenting for RALP. (Cite this article as: Hernandez-Meza G, Gainsburg DM. Anesthetic concerns for robotic-assisted laparoscopic radical prostatectomy: an update. Minerva Anestesiol 2023;89:812-23. DOI: 10.23736/S0375-9393.23.17284-1)

Automated summary

The anesthetic concerns of patients undergoing robotic-assisted laparoscopic radical prostatectomy primarily involve the use of pneumoperitoneum in the steep Trendelenburg position and its impact on cerebrovascular, ocular, respiratory, and hemodynamic homeostasis. Non-surgical complications range from mild subcutaneous emphysema to devastating ischemic optic neuropathy. Successful management requires thorough preoperative evaluation, careful positioning, ventilation management, and coordinated efforts between the anesthesia and surgical teams.